Identification and Characterization of Patient Populations at High Risk for Clostridioides difficile Infection (CDI): A Narrative Review

Clostridioides difficile infection (CDI) is a major cause of infections worldwide and can lead to life-threatening complications and a severe impact on patients' quality of life (QoL). CDI can affect anyone, but it is generally accepted that those at greatest risk include people receiving antibiotics, of older age, and with a compromised immune system. However, beyond these broad categories, specific populations at high risk for CDI are not clearly defined. We performed a literature search to identify and characterize patients at high risk for CDI. We found that those at high risk for CDI include patients undergoing hematopoietic stem cell transplant, solid organ transplant or chimeric antigen receptor T-cell therapy, or with chronic kidney disease/end-stage kidney disease, hematological malignancies or inflammatory bowel disease, or who are older and frail with comorbidities. In the identified patient populations, CDI was associated with significantly worse clinical outcomes, increased healthcare resource utilization and costs, and generally an increased risk of mortality compared with those without CDI. Patients at high risk for CDI have multiple risk factors for infection that further complicate management of their disease. Apart from older patients, there is a lack of information on the impact on QoL in high-risk populations. Prevention strategies for CDI in high-risk populations are lacking and are based on the general population. As such, there is a need to increase understanding of those at high risk for CDI and the significant impact infection has in these populations, and to identify preventive therapies to alleviate the burden on both patients and healthcare systems.