title: Role of cephalosporins in the era of Clostridium difficile infection.
abstract: The incidence of Clostridium difficile infection (CDI) in Europe has increased markedly since 2000. Previous meta-analyses have suggested a strong association between cephalosporin use and CDI, and many national programmes on CDI control have focused on reducing cephalosporin usage. Despite reductions in cephalosporin use, however, rates of CDI have continued to rise. This review examines the potential association of CDI with cephalosporins, and considers other factors that influence CDI risk. EUCLID (the EUropean, multicentre, prospective biannual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhoea) reported an increase in the annual incidence of CDI from 6.6 to 7.3 cases per 10 000 patient bed-days from 2011-12 to 2012-13, respectively. While CDI incidence and cephalosporin usage varied widely across countries studied, there was no clear association between overall cephalosporin prescribing (or the use of any particular cephalosporin) and CDI incidence. Moreover, variations in the pharmacokinetic and pharmacodynamic properties of cephalosporins of the same generation make categorization by generation insufficient for predicting impact on gut microbiota. A multitude of additional factors can affect the risk of CDI. Antibiotic choice is an important consideration; however, CDI risk is associated with a range of antibiotic classes. Prescription of multiple antibiotics and a long duration of treatment are key risk factors for CDI, and risk also differs across patient populations. We propose that all of these are factors that should be taken into account when selecting an antibiotic, rather than focusing on the exclusion of individual drug classes.
authors.affiliation: Leeds Institute of Biomedical and Clinical Sciences, Faculty of Medicine and Health, University of Leeds, and Microbiology, Leeds Teaching Hospitals, Leeds, UK mark.wilcox@nhs.net.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
authors.affiliation: Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
authors.forename: James D
authors.initials: JD
authors.lastname: Chalmers
authors.affiliation: Department of Laboratory Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Nord
authors.affiliation: Leeds Institute of Biomedical and Clinical Sciences, Faculty of Medicine and Health, University of Leeds, and Microbiology, Leeds Teaching Hospitals, Leeds, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002511:Cephalosporins / Q000009:adverse effects*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D018570:Risk Assessment
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins