title: Evaluating contemporary antibiotics as a risk factor for Clostridium difficile infection in surgical trauma patients.
abstract: BACKGROUND
  With most Clostridium difficile infections (CDI) occurring after exposure to antimicrobial treatment, specific antibiotics and duration of exposure were evaluated independently for increased risk of CDI in surgical patients.
  
  
  METHODS
  A retrospective, case-control design was used to study surgical inpatients. The case group had a positive Clostridium difficile toxin assay, whereas the control group did not.
  
  
  RESULTS
  Four antibiotics had a risk that was statistically significant for causing CDI in surgical patients: cefepime (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.7-19.1; p = 0.0044), imipenem/cilastatin (OR, 3.2; 95% CI, 1.2-8.9; p = 0.0388), piperacillin/tazobactam (OR, 2.4; 95% CI, 1.3-4.5; p = 0.0067), and vancomycin (OR, 1.9; 95% CI, 1.0-3.5; p = 0.0439). Exposure longer than 7 days to cefepime (p = 0.0006), piperacillin/tazobactam (p = 0.0021), and imipenem/cilastatin (p = 0.0171) also increased risk for development of CDI.
  
  
  CONCLUSIONS
  The use of cefepime, imipenem/cilastatin, piperacillin/tazobactam, and vancomycin and the use of multiple classes of antibiotics for at least 7 days significantly increased the risk of CDI in surgical inpatients.
authors.affiliation: Department of Pharmacy, University of Louisville Health Care, Louisville, Kentucky 40202, USA. krutish@ulh.org
authors.forename: Kruti
authors.initials: K
authors.lastname: Shah
authors.forename: Leigh Ann
authors.initials: LA
authors.lastname: Pass
authors.forename: Mark
authors.initials: M
authors.lastname: Cox
authors.forename: Matthew
authors.initials: M
authors.lastname: Lanham
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016001:Confidence Intervals; D004341:Drug Evaluation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007629:Kentucky / Q000453:epidemiology; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents