title: Prospective study of the risk of Clostridium difficile diarrhoea in elderly patients following treatment with cefotaxime or piperacillin-tazobactam.
abstract: BACKGROUND
  Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.
  
  
  OBJECTIVE
  To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin-tazobactam (PT).
  
  
  METHODS
  A prospective, ward-based, crossover study was carried out on two well-matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad-spectrum antibiotic treatment.
  
  
  RESULTS
  There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P=0.001) and diarrhoea (18/34 vs. 1/14, P=0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment.
  
  
  CONCLUSIONS
  Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.
authors.affiliation: Department of Microbiology, The General Infirmary at Leeds and The University of Leeds, Old Medical School, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Settle
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
authors.forename: W N
authors.initials: WN
authors.lastname: Fawley
authors.forename: O J
authors.initials: OJ
authors.lastname: Corrado
authors.forename: P M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D000368:Aged; D002439:Cefotaxime / Q000009:adverse effects*; D016360:Clostridioides difficile; D003428:Cross Infection / Q000382:microbiology; D018592:Cross-Over Studies; D003967:Diarrhea / Q000382:microbiology*; D004338:Drug Combinations; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009894:Opportunistic Infections / Q000382:microbiology; D010397:Penicillanic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000009:adverse effects*; D011446:Prospective Studies; D000078142:Tazobactam; D065093:beta-Lactamase Inhibitors
chemical_list: D004338:Drug Combinations; D004791:Enzyme Inhibitors; D065093:beta-Lactamase Inhibitors; D010397:Penicillanic Acid; D002439:Cefotaxime; D000078142:Tazobactam; D010878:Piperacillin