(215) Opioid Use and Its Association with Clostridium difficile Infection: A Systematic Review and Meta-Analysis of Observational Studies

Background: Clostridium difficile (CD) is a leading cause of nosocomial infections, especially in immunocompromised individuals. Recent discussions suggest that opioid use could heighten the risk of CD infection in hospitalized patients.

Objectives: To conduct a systematic review and meta-analysis of observational studies to determine the association of opioid use with Clostridium difficile infection among these patients.

Methods: A comprehensive literature search was conducted from inception until January 2024 across PubMed/MEDLINE, Web of Science, and Cochrane Library. The reference lists of identified studies were scanned for any additional relevant studies. Observational studies, specifically cohort and case-control studies, exploring the association between opioid use and Clostridium difficile infection in a hospital setting were included. Meta-analysis was performed utilizing a random-effects model within R Statistical Software, version 4.3.2.

Results: Out of the initial 1,521 articles retrieved from the search, five were selected for the systematic review, with four included in the meta-analysis, totaling 119,145 patients. Among these, 42,794 were using opioids, and 76,351 were not. There were 13,399 cases of CD infection in opioid users compared to 13,184 in non-users. The Odds Ratio (OR) was 1.93, indicating a significant association between opioid use and CD infection risk (95% CI: 1.37-2.49, p-value: < 0.0001), highlighting an increased infection risk in opioid users.

Conclusions: Our findings indicate that opioid use in hospitalized patients is associated with an increased risk of Clostridium difficile infection. This highlights the need for further studies to assess the impact of opioid use on the severity of these infections. Given the higher risk, particularly for immunocompromised individuals, clinicians should be mindful of this association when prescribing opioids, emphasizing the importance of cautious opioid use in vulnerable patient populations.