New research from the University of Georgia suggests that opioid use could make patients more vulnerable to infections.
Clostridioides difficile, also known as C. diff, is a highly contagious bacteria that infects the colon. About 500,000 people get it each year, and it's especially common in hospitals and nursing homes.
The illness causes severe diarrhea, nausea and vomiting. In the most serious cases, C. diff can even lead to death.
People taking certain antibiotics or with weakened immune systems are especially at risk of developing the disease. Using opioids could be another risk factor, according to the new paper.
"There is mixed evidence on the association between these medications and C. diff," said Lorenzo Villa-Zapata, a co-author of the publication and an assistant professor in UGA's College of Pharmacy. "The main thing for us is to provide evidence that doctors can use when prescribing medications so they can weigh the benefits and side effects."
The meta-analysis examined four studies of almost 120,000 patients. The researchers found that about 31% of patients who were prescribed and taking opioids caught C. diff, compared to 17% of patients who weren't using them.
Weakened immune systems, changes in gut bacteria increase risk of infection
Past research suggests that opioids can suppress the immune system's ability to fight off infections. They also disrupt the balance of good bacteria in the gut. These bacteria not only aid digestion but also help defend against pathogens like C. diff.
By creating an environment more favorable to harmful bacteria and hampering the immune system's defense, opioid use may heighten susceptibility to infection, especially for hospitalized patients.
"Opioids mess with the gut microbiome, and that creates an environment that is more likely to support C. diff colonization," said Pooja Gokhale, lead author of the study and a doctoral candidate in UGA's College of Pharmacy. "And because opioids can lead to immunosuppression, you're more susceptible to infections in general, and of course, C. diff is a highly infectious disease."
Doctors should consider a patient's risk of infection when prescribing opioids
This doesn't mean that doctors should never prescribe opioids, the researchers said. C. diff is more common among patients in health care facilities, and some patients are at a lower risk for infection than others.
The researchers said doctors should consider the individual patient's needs.
"It has to be case by case. Each patient has a very different history," said Gokhale. "If it's a healthy young patient, physicians may not be as concerned about the risk, but hospitalized or immunocompromised patients are already at high risk."
The study was published in the American Journal of Infection Control.
