title: Risk of Clostridium difficile infection in intensive care unit patients with sepsis exposed to metronidazole.
abstract: BACKGROUND
  Antimicrobial agents used to treat Clostridium difficile infection (CDI), such as metronidazole and vancomycin, have been used during antibiotic treatment of other infections to try to prevent the development of CDI. We evaluated the hypothesis that intensive care unit (ICU) patients who receive metronidazole as part of an antibiotic treatment regimen for sepsis have a lower risk of subsequently developing CDI.
  
  
  METHODS
  This was a nested case-control study in a cohort of ICU patients who received antibiotic therapy for sepsis.
  
  
  RESULTS
  A total of 10 012 patients aged ≥ 18 years were admitted to the Cooper University Hospital medical/surgical ICU from 1/1/2003 to 12/31/2008. After applying inclusion criteria including having received antibiotic therapy for sepsis and subsequently having developed CDI, 67 cases were identified. The cases were matched for age, gender, date of ICU admission, and hospital length of stay to 67 controls that also received antibiotic therapy for sepsis but did not subsequently develop CDI. In the multivariate analysis, there was no association between metronidazole exposure and the risk of CDI (odds ratio (OR) = 0.57; p = 0.23). The only significant associations on multivariate analysis were antifungal therapy (OR = 0.30; p = 0.02) and aminoglycoside and/or colistin therapy (OR = 0.17; p = 0.02).
  
  
  CONCLUSIONS
  No association was found between metronidazole use and subsequent CDI in ICU patients who received antibiotic therapy for sepsis.
authors.affiliation: From the 1 Division of Infectious Diseases.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Sabbah
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: Quinn A
authors.initials: QA
authors.lastname: Czosnowski
authors.forename: Krystal
authors.initials: K
authors.lastname: Hunter
authors.forename: Marc C
authors.initials: MC
authors.lastname: Torjman
authors.forename: Henry S
authors.initials: HS
authors.lastname: Fraimow
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti
authors.forename: Constantine
authors.initials: C
authors.lastname: Tsigrelis
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008795:Metronidazole / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole
keywords: Clostridium difficile; case-control studies; intensive care; metronidazole; sepsis