DDW 2018—Opioids negatively affect recovery from C diff

  • Bob Roehr
  • Conference Reports
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  • Physicians should avoid or minimize use of opioids in patients with Clostridium difficile infection (CDI) as it worsens symptoms and extends hospitalization.

Why this matters

  • Prescription use of opioids has increased in recent years, particularly in a hospital setting.
  • Antimotility, decreased transit time through the bowel, is a common side effect of opioid use and can contribute to dysbiosis.
  • This can hinder recovery from CDI, extend hospitalization, and increase costs.

Study design

  • Retrospective inpatient chart review of 209 adults (≥18) diagnosed with CDI over a 2-year period.
  • Patients were categorized as either no exposure to opioids or by levels of morphine equivalence.
  • Severity of CDI was stratified as mild-moderate-severe as categorized by Infectious Disease Society of America (IDSA) guidelines.
  • Comparisons were by chi-square, t-test, and multivariate analysis using logistic regression.

Key results

  • Average length of hospitalization was significantly higher in the opioid group (14.6 vs 9.1 days).
  • Opioid patients were more likely to experience severe CDI (59.2% vs 38.3%).
  • Readmission for opioid patients was significantly higher (38.2% vs 22.2%).
  • 30-day mortality was higher in the opioid group (29.2% vs 18.8%) but did not achieve statistical significance.


  • Single-center retrospective study.
  • Mean age in the opioid group was significantly lower (65.8 vs 75.8 years).
  • Setting was Charleston, West Virginia, which has high levels of opioid use that may not be reflective of other regions.

Expert commentary

  • Dr. Chowdhary said opioid use did not necessarily cause more CDI but it did contribute to its severity; other work has shown an association between opioid exposure and higher incidence of CDI.
  • The investigators are continuing to analyze a possible dose/duration effect of exposure to opioids.
  • Nonopioid analgesics and shorter, less intense, use of opioids should be considered first.


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