From the Research
Post-stroke patients are at increased risk of developing Clostridium difficile infection (CDI), with prior stroke being a significant risk factor, as evidenced by a study published in 2010 1. The primary risk factors for CDI in post-stroke patients include:
- Antibiotic exposure, particularly broad-spectrum antibiotics often used to treat post-stroke infections like pneumonia or urinary tract infections
- Prolonged hospitalization, which increases exposure to C. difficile spores in healthcare environments
- Advanced age, which is common in stroke patients and independently increases CDI risk
- Immunosuppression resulting from stroke-induced immune dysfunction, which further compromises the body's ability to resist infection
- Gastric acid suppression medications like proton pump inhibitors, which reduce the stomach's natural barrier against pathogens
- Enteral tube feeding, which disrupts normal gut flora
- Physical immobility, which leads to constipation and altered gut motility, creating favorable conditions for C. difficile proliferation
- Comorbidities like diabetes or renal failure, which independently increase CDI risk A more recent study published in 2022 found that CDI incidence following stroke was low, but male sex and steroid use were associated with a positive C. difficile test result 2. However, the most recent and highest quality study on this topic is not available, but based on the available evidence, healthcare providers should practice antibiotic stewardship, implement strict infection control measures, minimize unnecessary acid-suppressing medications, and maintain vigilance for early CDI symptoms in this vulnerable population. It is also important to note that the treatment of CDI is evolving, with new therapeutic approaches being developed and tested, including new antibiotics, antibiotic inactivators, monoclonal antibodies, and gut microbiota modulating therapies 3. In terms of specific risk factors, a study published in 2014 found that high-risk antimicrobials, community-onset healthcare-associated CDI, and fluoroquinolones were associated with an increased risk of recurrent CDI 4. Overall, post-stroke patients are at increased risk of developing CDI, and healthcare providers should take steps to mitigate this risk and prevent the spread of C. difficile in healthcare environments.