The addictive nature of opioids and the increasing number of overdoses and fatalities in America has been intensively researched and publicized, but there has been limited study of the potentially dangerous impact of opioids on hospitalized patients. As a medical
resident in the hospital setting, I often treat patients with Clostridium difficile (C. diff), the most common hospital-acquired infection in the U.S. Many of these patients are prescribed opioids during their hospital stay, either as a continuation of opioids they received as outpatients, or newly prescribed for pain.
The incidence of C. diff has been rising alarmingly over the past two decades, with subsequent increases in mortality, prolonged hospital stays requiring higher-level care, and a substantial rise in healthcare costs. According to the Centers for Disease Control and Prevention, C. diff causes up to half a million infections and 29,000 deaths annually.
In my work at West Virginia University Health Sciences Center at Charleston, I have been looking for ways we can improve care for patients with C. diff to assure better outcomes. As my team and I began this effort, we noticed that many C. diff patients were receiving opioids during treatment.
It is well-known in the medical community that opioids slow gastrointestinal movement, which can alter the microbiome of the intestine thus predisposing it to infection. However, there is limited data on the impact of opioid use in patients with C. diff.
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Study: Opioid use in hospitalized patients with C. difficile
We compared the outcomes of patients with C. diff who were taking opioids to those who were not. Our study, which is being presented at Digestive
Disease Week® (DDW) 2018, examined the records of 209 patients over a two-year span at the hospital. We found that opioid use is associated with an increased risk of severe C. diff and extended length of hospitalization.
Unlike mild C. diff, severe infection can include watery diarrhea 10 to 15 times a day, abdominal cramping and pain, rapid heart rate, fever, blood or pus in the stool, nausea, dehydration, swollen abdomen, kidney failure, and increased white blood cell count, and may require admission to the Intensive Care Unit.
Using a retrospective chart review of all in-patients with C. diff, we found more than three quarters (77 percent) were prescribed opioids. The study found that the length of stay was significantly higher in the opioid group (15 days) compared to the non-opioid group (nine days). Additionally, more patients in the opioid group had severe C. diff (59 percent) than the non-opioid group (38 percent).
These findings suggest that providers should avoid prescribing opioids to patients with C. diff as often as possible. It is one of the first studies to look specifically at the impact of opioids on C. diff, and although it’s not a causal study, it does point towards the harm associated with using opioids to relieve pain in these patients and makes the case for physicians to explore other options for pain relief, including acetaminophen or non-steroidal
anti-inflammatory drugs (NSAIDs) before considering opioids.
Because these patients are extremely costly to the health care system, we should be spending more time looking at how to modify their risk factors. Additionally, studies are
needed to determine if there is a causal connection between opioid use and developing severe C. diff.
associated with severe disease and prolonged hospitalization,” abstract Sa1843, on Saturday, June 2 from noon to 2 p.m. EDT, at the Walter E. Washington Convention Center in Washington, D.C. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit www.ddw.org/press.
Monica Chowdhry MD
Dr. Chowdhry is a second-year internal medicine resident and upcoming chief resident at West Virginia University Charleston Division. She attended medical school at Jawaharlal Nehru Medical College in India. Her future interests are hepatology.