Skip to main content

Opioids for C diff Pain Connected to Worse Outcomes

      

ORLANDO — For patients infected with Clostridium difficile, significant opioid use appears to be associated with increases in the severity of infection and in-hospital mortality, new research suggests.
"As physicians, when we see someone in pain, we often will default to opioids. This study raises awareness that, in C difficile patients in particular, opioids should be avoided," said Elizabeth John, MD, from Rutgers University in New Brunswick, New Jersey.
Opioid use has not been typically associated with C difficile infection. However, in a preliminary study, Dr John and her colleagues found an association between opioid use, longer hospital stays, and higher white blood cell counts in infected patients (Gastroenterology. 2017;5[Suppl 1]:S347).
In a follow-up study, which Dr John presented here at the World Congress of Gastroenterology 2017, the researchers reviewed the medical records of 302 adults with clinically diagnosed C difficile infection. All patients were hospitalized for a minimum of 3 days.
Patients who were dispensed a morphine-equivalent dose of an opioid of at least 10 mg during their hospital stay were assigned to the opioid group. All other patients served as the control group. Regression analyses controlled for the previous use of antibiotics, the use of acid suppressive medication, the source of infection (hospital vs community), comorbidities, and demographic characteristics.
Severe or complicated C difficile infection was more common in the opioid group than in the control group. And the rate of complicated infection alone was higher in the opioid group.
Average hospital stay was longer in the opioid group than in the control group (25 vs 15 days; adjusted incidence rate ratio, 1.46; P = .03). And the in-hospital mortality rate was higher in the opioid group.
Now I know we are on to something.
"I was surprised by how strong the findings were," Dr John told Medscape Medical News. "They make sense to me, but after seeing them validated in a large sample population, now I know we are on to something."
Because opioids are known to slow the gastrointestinal tract, they might increase the absorption of C difficile bacterial toxins, she suggested.
"Given the opioid abuse epidemic, this study highlights another reason for patients and their healthcare providers to carefully consider alternative agents to opioids," Keith Obstein, MD, from Vanderbilt University in Nashville, Tennessee, said when asked to comment by Medscape Medical News.
Dr John and Dr Obstein have disclosed no relevant financial relationships.
World Congress of Gastroenterology 2017: Poster P103. Presented October 15, 2017.
Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter

Comments

Post a Comment

Popular posts from this blog

Contact Precautions May Have Unintended Consequences

Contact precautions, including gloves, gowns, and isolated rooms, have helped stem the transmission of hospital pathogens but have also had some negative consequences, according to findings from a new study. Healthcare worker (HCWs) visited patients on contact precautions less frequently than other patients and spent less time with those patients when they did visit, report Daniel J. Morgan, MD, from the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System, Baltimore, and colleagues. Moreover, patients on contact precautions also received fewer outside visitors. "Less contact with HCWs suggests that other unintended consequences of contact precautions still exist," Dr. Morgan and coauthors write. "The resulting decrease in HCW contact may lead to increased adverse events and a lower quality of patient care due to less consistent patient monitoring and poorer adherence to standard adverse event prevention methods (such...
Post a Comment
Read more

CareFusion Issues Update on Infant Breathing Product Recall

July 5, 2012 — Medical device maker CareFusion has issued an update reminding healthcare providers of its voluntary recall of its Air Life ™ Infant Breathing Circuit, initiated back in May. The US Food and Drug Administration (FDA) has classified this action as a class 1 recall, meaning there is a reasonable probability of serious adverse health consequences or death associated with use of the defective units. The update was posted July 2 on the FDA  Website. On May 29, 2012, CareFusion sent an  Urgent Recall Notice  to customers and distributors stating that the company had identified potential risks associated with the Air Life  Infant Breathing Circuit. The action was initiated after the company received complaints of the Y adapter within the breathing circuit developing cracks during patient use. "If a crack develops in the Y adapter, this could potentially result in a leak in the closed ventilation system, leading to a loss in the intended tidal volum...
Post a Comment
Read more

FDA Approves Tapentadol ER for Diabetic Neuropathy

August 29, 2012 — The US Food and Drug Administration (FDA) has approved tapentadol extended-release (ER) ( Nucynta , Janssen Pharmaceuticals, Inc) for the management of neuropathic pain associated with diabetic peripheral neuropathy (DPN) in adults for whom a continuous opioid analgesic is required over an extended time. It is the first opioid to receive this indication, the company notes in a statement today. DPN, the most common type of neuropathy, affects an estimated 16% of the more than 25 million Americans who have diabetes. The condition is often unreported and untreated, with an estimated 2 out of 5 cases not receiving care. Tapentadol ER is already approved for the treatment of moderate to severe chronic pain in adults requiring a continuous opioid analgesic for an extended period. It is a centrally acting synthetic analgesic, although the exact mechanism of action is unknown, the release states. "Although the clinical relevance is unclear," the company n...
4 comments
Read more