Clostridioides difficile infection (CDI), a common antibiotic-associated infection, may be linked to oral mucositis. The large study was published on September 5 in Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology.
The study highlights the importance of including routine oral health assessments in the care of individuals with CDI, the authors wrote.
“Oral mucositis represents a clinically significant complication that warrants careful attention in patients with CDI, as it may adversely affect quality of life even after the infection has resolved,” wrote co-author Dr. Adepitan A. Owosho of the Robert Ebert and Greg Stubblefield Head and Neck Tumor Center with Barnes-Jewish Hospital and the Washington University School of Medicine in St. Louis.
In the U.S., CDI is recognized as one of the top five antibiotic-related urgent public health threats, affecting more than 400,000 individuals and associated with 29,000 deaths per year. The link between CDI and oral mucositis has been noted in patients with cancer, but its occurrence in the broader populations has not been investigated, according to the study.
To determine whether adults with CDI face a heightened risk of developing oral mucositis compared to those without the infection, a retrospective cohort study that included 227,402 patients with CDI and 227,505 patients without CDI was conducted. The TriNetX real-world dataset examined patients with confirmed CDI. Those with prior oral mucositis, leukemia, chemotherapy or radiotherapy exposure, and other major comorbidities were excluded.
The occurrence of oral mucositis was 0.035% (n = 79) in those with CDI compared to 0.015% (n = 35) in those without CDI. This translates to a risk difference of 0.019% and a statistically significant twofold increased relative risk (2.26) (p <0.0001), suggesting a possible correlation between oral mucositis and CDI, they wrote.
The study had limitations. International Classification of Diseases-coded entries within the TriNetX platform were used to identify oral mucositis. Therefore, all cases may not have been captured. Direct clinician chart review would have improved diagnostic accuracy, the authors wrote.
“While the absolute risk remains low, the statistically significant two-fold increase in relative risk suggests that oral mucositis may represent an underrecognized and underreported complication of CDI,” Owosho wrote.
