Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients
- PMID: 18171186
- DOI: 10.1086/524320
Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients
Abstract
Objective: To determine which antibiotics increase or decrease the risk of Clostridium difficile-associated diarrhea (CDAD).
Design: Retrospective case-control study.
Setting: Nonprofit, integrated healthcare delivery system in Northern California.
Patients: Study participants included patients with cases of hospital-acquired CDAD that occurred during the period from 1999 through 2005 (n=1,142) and control patients (n= 3,351) matched for facility, calendar quarter during which hospitalization occurred, diagnosis related group for the index hospitalization, and length of hospital stay. All case and control patients had received antibiotics in the 60 days before the index date. For each antibiotic, the risk of CDAD was examined in relation to whether the patient received the antibiotic, after adjustment for use of other antibiotics, demographic characteristics, selected health conditions, and use of healthcare services.
Results: The following antibiotics were associated with a significantly increased risk of acquiring CDAD: imipenem-cilastin (odds ratio [OR], 2.77), clindamycin (OR, 2.31), cefuroxime (OR, 2.16), moxifloxacin (OR, 1.88), ceftazidime (OR, 1.82), cefpodoxime (OR, 1.58), ceftizoxime (OR, 1.57), and ceftriaxone (OR, 1.49). Metronidazole and doxycycline were associated with a significantly reduced risk of CDAD (OR for metronidazole, 0.67; OR for doxycycline, 0.41). Other factors associated with an increased risk of CDAD were older age, longer hospital stays, use of proton pump inhibitors, prior gastrointestinal disease, and prior infection (not including C. difficile infection.)
Conclusions: Some antibiotics appear to increase the risk of acquiring CDAD, notably clindamycin, third-generation cephalosporins, and carbapenems, whereas metronidazole and doxycycline appear to be protective, compared with other antibiotics.
Similar articles
-
Epidemiology of suspected Clostridium difficile-associated hospital-acquired diarrhea in hospitalized patients at Siriraj Hospital.J Med Assoc Thai. 2011 Feb;94 Suppl 1:S207-16. J Med Assoc Thai. 2011. PMID: 21721449
-
Is it Clostridium difficile infection or something else? A case-control study of 352 hospitalized patients with new-onset diarrhea.South Med J. 2007 Aug;100(8):782-6. doi: 10.1097/SMJ.0b013e318063e9c5. South Med J. 2007. PMID: 17713303
-
Nosocomial diarrhoea in adult medical patients: the role of Clostridium difficile in a North Italian acute care teaching hospital.J Prev Med Hyg. 2009 Jun;50(2):117-20. J Prev Med Hyg. 2009. PMID: 20099443
-
Established and potential risk factors for Clostridum difficile infection.Indian J Med Microbiol. 2009 Oct-Dec;27(4):289-300. doi: 10.4103/0255-0857.55436. Indian J Med Microbiol. 2009. PMID: 19736396 Review.
-
Clostridium difficile-associated diarrhea and colitis.J Calif Dent Assoc. 1999 May;27(5):405-9, 411-3. J Calif Dent Assoc. 1999. PMID: 10528559 Review.
Cited by 40 articles
-
Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing.JAMA Netw Open. 2021 Apr 1;4(4):e218367. doi: 10.1001/jamanetworkopen.2021.8367. JAMA Netw Open. 2021. PMID: 33914051 Free PMC article.
-
A Risk Score to Predict Clostridioides difficile Infection.Open Forum Infect Dis. 2021 Feb 4;8(3):ofab052. doi: 10.1093/ofid/ofab052. eCollection 2021 Mar. Open Forum Infect Dis. 2021. PMID: 33738316 Free PMC article.
-
Can Inflammatory Markers Foretell Aetiology and Prolonged Hospitalisation in Acute Pancreatitis?Cureus. 2021 Jan 7;13(1):e12566. doi: 10.7759/cureus.12566. Cureus. 2021. PMID: 33564553 Free PMC article.
-
Doxycycline Malaria Prophylaxis Impact on Risk of Travelers' Diarrhea among International Travelers.Am J Trop Med Hyg. 2020 Nov;103(5):1864-1870. doi: 10.4269/ajtmh.20-0241. Am J Trop Med Hyg. 2020. PMID: 32815505 Free PMC article.
-
Clostridium difficile infection in an academic medical center in Saudi Arabia: prevalence and risk factors.Ann Saudi Med. 2020 Jul-Aug;40(4):305-309. doi: 10.5144/0256-4947.2020.305. Epub 2020 Aug 6. Ann Saudi Med. 2020. PMID: 32757991 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical