title: Risk of Clostridium difficile infection in hospitalized patients receiving metronidazole for a non-C difficile infection.
abstract: OBJECTIVE
  Antibiotics often are given to prevent infections but also constitute a risk factor for Clostridium difficile infection (CDI). Metronidazole is an effective treatment for CDI. We investigated whether prophylactic administration of metronidazole to patients before they receive other antibiotics reduces the risk of CDI.
  
  
  METHODS
  We performed a retrospective cohort analysis of data collected from 12,026 high-risk patients admitted to Cleveland Clinic Foundation Hospitals from 2008 through 2012. High-risk patients were defined as age 55 or older who received a broad-spectrum antibiotic (piperacillin-tazobactam or ciprofloxacin) and a gastric acid suppressant (a proton pump inhibitor or a histamine-2 receptor blocker) during their hospitalization. Development of CDI was compared between patients who received metronidazole for non-CDI indications before broad-spectrum antibiotics (n = 811) and those who did not (n = 11,215). Logistic regression was used to control for patient demographics and comorbidities.
  
  
  RESULTS
  The rate of CDI was 1.4% (n = 11) among the patients who received metronidazole for non-CDI indications and 6.5% (n = 728) among those who did not. This was observed to be an 80% reduction in CDI among patients who received metronidazole (odds ratio, 0.21; 95% confidence interval, 0.11-0.38; P < .001), adjusted for age, sex, and comorbidities.
  
  
  CONCLUSIONS
  Based on a retrospective analysis, metronidazole might be used to prevent CDI in certain high-risk patients. Prospective controlled trials are necessary before making further recommendations.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida. Electronic address: rodrigs3@ccf.org.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rodriguez
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Marlow B
authors.initials: MB
authors.lastname: Hernandez
authors.affiliation: Department of Infectious Disease, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Tarchini
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Megan
authors.initials: M
authors.lastname: Zaleski
authors.affiliation: Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Marjon
authors.initials: M
authors.lastname: Vatanchi
authors.affiliation: Department of Infectious Disease, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Lyssette
authors.initials: L
authors.lastname: Cardona
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Fernando
authors.initials: F
authors.lastname: Castro-Pavia
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida.
authors.forename: Alison
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole
keywords: Antibiotic; Diarrhea; Prevention; Prophylaxis