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Nonsteroidal Anti-Inflammatory Drugs Impact on the Outcomes of Hospitalized Patients with Clostridium difficile Infection

Authors Patel H, Makker J, Vakde T, Shaikh D, Badipatla K, Dunne J, Mantri N, Nayudu SK, Glandt M, Balar B, Chilimuri S

Received 19 July 2019

Accepted for publication 21 November 2019

Published 10 December 2019 Volume 2019:12 Pages 449—456

DOI https://doi.org/10.2147/CEG.S223886

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Everson L.A. Artifon


Harish Patel,1,2 Jasbir Makker,1,2 Trupti Vakde,1,3 Danial Shaikh,1,2 Kanthi Badipatla,1,2 James Dunne,4 Nikhitha Mantri,1 Suresh Kumar Nayudu,1,2 Mariela Glandt,1 Bhavna Balar,1,2 Sridhar Chilimuri1,2

1Department of Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 2Division of Gastroenterology, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 3Division of Pulmonary and Critical Care Medicine, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA; 4Support Service and Operation, Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA

Correspondence: Jasbir Makker
Bronx Care Health System, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Selwyn Ave, Bronx, NY, USA
Tel +1 7185181234
Email jmakker@bronxleb.org

Purpose: Mouse model experiments have demonstrated an increased Clostridium difficile infection (CDI) severity with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) use. We aim to evaluate the impact of NSAIDs in humans after a diagnosis of CDI on primary outcomes defined as I) all-cause mortality and II) toxic mega-colon attributable to CDI.
Patients and methods: All hospitalized patients with a diagnosis of CDI were divided into two groups; those with NSAIDs administered up to 10 days after onset of CDI versus no NSAIDs use. The primary outcomes were analyzed between the groups, while controlling for severity of CDI. A logistic regression analysis was performed to identify the predictors of worse outcomes.
Results: NSAIDs were administered in 14% (n=80) of the 568 hospitalized visits for an average of 2.5 days after the CDI diagnosis. All-cause mortality was high in patients who did not receive NSAIDs as compared to those who did receive NSAIDs (16.6% vs 12.5%, p 0.354). Patients who were prescribed NSAIDs were more likely to have toxic mega-colon as compared to those who were not prescribed NSAIDs (2.5% vs 0.6%, p 0.094). Results were not statistically significant, even after controlling for CDI severity. Logistic regression analysis did not identify NSAIDs administration as a significant factor for all-cause mortality in CDI patients.
Conclusion: This retrospective study results, contrary to mouse model, did not show association between NSAID use and CDI related mortality and toxic mega-colon. Shorter duration of NSAIDs use, younger people in study group, and timely CDI treatment may have resulted in contrasting results.

Keywords: colitis, NSAIDs, Clostridium difficile infection, nonsteroidal anti-inflammatory drugs, toxic megacolon

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