title: Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis.
abstract: Antibiotics have been the most important risk factor for Clostridium difficile infection (CDI). However, only data from non-randomised studies have been reviewed. We sought to evaluate the risk for development of CDI associated with the major antibiotic classes by analysing data from randomised controlled trials (RCTs). The PubMed, Cochrane and Scopus databases were searched and the references of selected RCTs were also hand-searched. Eligible studies should have compared only one antibiotic versus another administered systemically. Inclusion of studies comparing combinations of antibiotics was allowed only if the second antibiotic was the same or from the same class or if it was administered in a subset of the enrolled patients who were equally distributed in the two arms. Only a minority of the selected RCTs (79/1332; 5.9%) reported CDI episodes. Carbapenems were associated with more CDI episodes than fluoroquinolones [risk ratio (RR) = 2.44, 95% confidence interval (CI) 1.32-4.49] and cephalosporins (RR = 2.24, 95% CI 1.46-3.42), but not penicillins (RR = 2.53, 95% CI 0.87-7.41). Cephalosporins were associated with more CDIs than penicillins (RR = 2.36, 95% CI 1.32-4.23) and fluoroquinolones (RR = 2.84, 95% CI 1.60-5.06). There was no difference in CDI frequency between fluoroquinolones and penicillins (RR = 1.34, 95% CI 0.55-3.25). Finally, clindamycin was associated with more CDI episodes than cephalosporins and penicillins (RR = 3.92, 95% CI 1.15-13.43). In conclusion, data from RCTs showed that clindamycin and carbapenems were associated with more CDIs than other antibiotics.
authors.affiliation: Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece. Electronic address: k.vardakas@aibs.gr.
authors.forename: Konstantinos Z
authors.initials: KZ
authors.lastname: Vardakas
authors.affiliation: Alfa Institute of Biomedical Sciences, Athens, Greece.
authors.forename: Kyriakos K
authors.initials: KK
authors.lastname: Trigkidis
authors.affiliation: Department of Applied Mathematics and Physics, National Technical University of Athens, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Boukouvala
authors.affiliation: Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000139:chemically induced* / Q000382:microbiology*; D003967:Diarrhea / Q000139:chemically induced* / Q000382:microbiology*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Clostridium difficile; Colitis; Diarrhoea