Paradigms in Flux: You Really Can Get C. difficile Infection After Laxative Use (and Bad Things Can Happen)

Reviewed by: Scott Curry, MD; Medical University of South Carolina

Authors from Beth Israel Deaconess examined outcomes for a retrospective cohort of 209 patients with C. difficile infections (CDI), 65 of whom had received laxatives within the 48 hours prior to diagnosis. There were no significant differences in the proportion of patients with severe CDI by four clinical severity scoring systems. The rates of serious adverse outcomes attributable to CDI including death, ICU admission, colectomy, were 10.8% and 9.0% in laxative-treated and controls, respectively (P=0.80). One colectomy attributable to CDI occurred in each group, and CDI-attributable deaths occurred in 1 and 4 of the laxative-treated and control groups, respectively. Rates of recurrence were 3.1% and 5.6% in the laxative-treated and control groups(P=0.73). Most patients in the cohort treated with laxatives received combinations of laxatives and/or docusate. The authors conclude that recent laxative use does not preclude diagnosis of CDI and is not associated with reduced CDI severity or recurrence likelihood. Electronic hard stops for CDI testing in laxative-treated patients (one among diagnostic stewardship steps proposed by the IDSA-SHEA guideline) may result in diagnostic delay and adverse outcomes, and institutions may need to consider developing an override process based on CDI severity criteria.


White NC, Mendo-Lopez R et al. Clin Infect Dis. 2019 Oct 4. pii: ciz978. doi: 10.1093/cid/ciz978. [Epub ahead of print] PMID: 31584632 

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