Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients.
OBJECTIVE
To determine which antibiotics increase or decrease the risk of Clostridium difficile-associated diarrhea (CDAD).


METHODS
Retrospective case-control study.


METHODS
Nonprofit, integrated healthcare delivery system in Northern California.


METHODS
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.
Baxter
Roger
R
Permanente Medical Group, Oakland, California 94612, USA. roger.baxter@kp.org
Ray
G Thomas
GT
Fireman
Bruce H
BH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000254:growth & development* / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004359:Drug Therapy, Combination; D004403:Dysentery / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents