Opioid use and risk of Clostridioides difficile infection in hospitalized patients: A systematic review and meta-analysis.

Clostridioides difficile infection (CDI) is a leading cause of nosocomial infections, particularly in immunocompromised individuals. Evidence suggests that opioid use may increase the risk of CDI in hospitalized patients. This systematic review and meta-analysis aims to assess the association between opioid use and CDI among hospitalized patients. A comprehensive literature search was conducted from inception to January 2024 across PubMed/MEDLINE, Web of Science, and the Cochrane Library. The search was supplemented by hand-searching reference lists of included articles. Observational studies comparing adult opioid users with nonusers in a hospital setting were included. The meta-analysis employed a restricted maximum likelihood random-effects model using R Statistical Software, version 4.3.2. From 1,521 articles initially retrieved, 4 met the inclusion criteria, comprising 119,145 patients. Of these, 42,794 were opioid users, and 76,351 were nonusers. There were 13,399 cases of CDI among opioid users, compared with 13,184 among nonusers. The meta-analysis revealed an odds ratio of 1.98 (95% confidence interval: 1.54-2.56), indicating a significantly higher risk of CDI in opioid users. The findings underscore the need for further research to explore the impact of opioid use on the severity of CDI. • Opioids may reduce immunity and change gut flora, raising C. difficile infection risk. • Hospital opioid use increases C. difficile infection risk; effects vary by medication. • More study is needed on opioid dose, type, length and C. difficile infection risks.