title: Empirical antimicrobial prescriptions in patients with Clostridium difficile infection at hospital admission and impact on clinical outcome.
abstract: OBJECTIVE
  To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-affiliated community hospital.
  
  
  METHODS
  We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.
  
  
  RESULTS
  Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8-28.5]; [Formula: see text]), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03-1.36]; [Formula: see text]), and age (OR, 1.1 [95% CI, 1.0-1.1]; [Formula: see text]) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8-15.8]; [Formula: see text]) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9-32.3]; [Formula: see text]) were independently associated with unnecessary antimicrobial prescriptions.
  
  
  CONCLUSIONS
  Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.
authors.affiliation: Memorial Hospital of Rhode Island, Pawtucket, Rhode Island 02860, USA. aurora_pop-vicas@brown.edu
authors.forename: Aurora
authors.initials: A
authors.lastname: Pop-Vicas
authors.forename: Eman
authors.initials: E
authors.lastname: Shaban
authors.forename: Cecile
authors.initials: C
authors.lastname: Letourneau
authors.forename: Angel
authors.initials: A
authors.lastname: Pechie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy*; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents