Antibiotic Prescribing Choices and Their Comparative C. Difficile Infection Risks: A Longitudinal Case-Cohort Study.
Clostridioides difficile infection
CDI
antibiotics
cohort study
comparative effectiveness
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
received:
11
11
2019
accepted:
18
02
2020
pubmed:
19
2
2020
medline:
29
4
2021
entrez:
19
2
2020
Statut:
ppublish
Résumé
Antibiotic use is the strongest modifiable risk factor for the development of Clostridioides difficile infection, but prescribers lack quantitative information on comparative risks of specific antibiotic courses. Our objective was to estimate risks of C. difficile infection associated with receipt of specific antibiotic courses. We conducted a longitudinal case-cohort analysis representing over 90% of Ontario nursing home residents, between 2012 and 2017. Our primary exposure was days of antibiotic receipt in the prior 90 days. Adjustment covariates included: age, sex, prior emergency department or acute care stay, Charlson comorbidity index, prior C. difficile infection, acid suppressant use, device use, and functional status. We examined incident C. difficile infection, including cases identified within the nursing home, and those identified during subsequent hospital admissions. Adjusted and unadjusted regression models were used to measure risk associated with 5- to 14-day courses of 18 different antibiotics. We identified 1708 cases of C. difficile infection (1.27 per 100 000 resident-days). Longer antibiotic duration was associated with increased risk: 10- and 14-day courses incurred 12% (adjusted relative risk [ARR] = 1.12, 95% confidence interval [CI]: 1.09, 1.14) and 27% (ARR = 1.27, 95% CI: 1.21,1.30) more risk compared to 7-day courses. Among 7-day courses with similar indications: moxifloxacin resulted in 121% more risk than amoxicillin (ARR = 2.21, 95% CI: 1.67, 3.08), ciprofloxacin engendered 89% more risk than nitrofurantoin (ARR = 1.89, 95% CI: 1.45, 2.68), and clindamycin resulted in 112% (ARR = 2.12, 95% CI: 1.32, 3.78) more risk than cloxacillin. C. difficile infection risk increases with antibiotic duration, and there are wide disparities in risks associated with antibiotic courses used for similar indications.
Sections du résumé
BACKGROUND
Antibiotic use is the strongest modifiable risk factor for the development of Clostridioides difficile infection, but prescribers lack quantitative information on comparative risks of specific antibiotic courses. Our objective was to estimate risks of C. difficile infection associated with receipt of specific antibiotic courses.
METHODS
We conducted a longitudinal case-cohort analysis representing over 90% of Ontario nursing home residents, between 2012 and 2017. Our primary exposure was days of antibiotic receipt in the prior 90 days. Adjustment covariates included: age, sex, prior emergency department or acute care stay, Charlson comorbidity index, prior C. difficile infection, acid suppressant use, device use, and functional status. We examined incident C. difficile infection, including cases identified within the nursing home, and those identified during subsequent hospital admissions. Adjusted and unadjusted regression models were used to measure risk associated with 5- to 14-day courses of 18 different antibiotics.
RESULTS
We identified 1708 cases of C. difficile infection (1.27 per 100 000 resident-days). Longer antibiotic duration was associated with increased risk: 10- and 14-day courses incurred 12% (adjusted relative risk [ARR] = 1.12, 95% confidence interval [CI]: 1.09, 1.14) and 27% (ARR = 1.27, 95% CI: 1.21,1.30) more risk compared to 7-day courses. Among 7-day courses with similar indications: moxifloxacin resulted in 121% more risk than amoxicillin (ARR = 2.21, 95% CI: 1.67, 3.08), ciprofloxacin engendered 89% more risk than nitrofurantoin (ARR = 1.89, 95% CI: 1.45, 2.68), and clindamycin resulted in 112% (ARR = 2.12, 95% CI: 1.32, 3.78) more risk than cloxacillin.
CONCLUSIONS
C. difficile infection risk increases with antibiotic duration, and there are wide disparities in risks associated with antibiotic courses used for similar indications.
Identifiants
pubmed: 32069358
pii: 5740194
doi: 10.1093/cid/ciaa124
pmc: PMC7935390
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
836-844Subventions
Organisme : CIHR
ID : 141798
Pays : Canada
Informations de copyright
Her Majesty the Queen in Right of Canada, as represented by the Public Health Ontario, 2020.
Références
Clin Infect Dis. 2018 Feb 1;66(4):514-522
pubmed: 29401273
J Antimicrob Chemother. 2015 Sep;70(9):2456-64
pubmed: 26066581
Health Serv Res. 2008 Aug;43(4):1424-41
pubmed: 18756617
Infect Control Hosp Epidemiol. 2015 Sep;36(9):1065-72
pubmed: 26078017
Am J Epidemiol. 2011 Mar 15;173(6):676-82
pubmed: 21330339
Cochrane Database Syst Rev. 2015 Nov 12;(11):CD010907
pubmed: 26560888
Clin Infect Dis. 2011 Jul 1;53(1):42-8
pubmed: 21653301
J Antimicrob Chemother. 2014 Apr;69(4):881-91
pubmed: 24324224
J Antimicrob Chemother. 2013 Sep;68(9):1951-61
pubmed: 23620467
Clin Infect Dis. 2019 Oct 15;69(9):1476-1479
pubmed: 30615129
Clin Infect Dis. 2019 Oct 15;69(9):1467-1475
pubmed: 30615108
Antimicrob Agents Chemother. 2013 May;57(5):2326-32
pubmed: 23478961
Can J Clin Pharmacol. 2003 Summer;10(2):67-71
pubmed: 12879144
Clin Infect Dis. 2011 Jul 1;53(1):20-5
pubmed: 21653298
J Clin Epidemiol. 1999 Dec;52(12):1165-72
pubmed: 10580779
J Antimicrob Chemother. 2017 Apr 1;72(4):1193-1201
pubmed: 27999064
BMC Infect Dis. 2016 Apr 18;16:159
pubmed: 27091232
Antimicrob Agents Chemother. 2006 Sep;50(9):3216-9
pubmed: 16940135
BMC Health Serv Res. 2011 Apr 15;11:78
pubmed: 21496257
PLoS One. 2014 Aug 26;9(8):e105454
pubmed: 25157757
Ann Intern Med. 2016 Jun 21;164(12):787-94
pubmed: 27088642
Int J Epidemiol. 2014 Jun;43(3):962-70
pubmed: 24603316
Antimicrob Agents Chemother. 2013 Aug;57(8):4094
pubmed: 23858064
CMAJ. 2017 Jun 26;189(25):E851-E860
pubmed: 28652480
JAMA Intern Med. 2017 Mar 1;177(3):407-419
pubmed: 28097303
Chest. 2001 Jan;119(1):185-95
pubmed: 11157603
J Antimicrob Chemother. 2013 Dec;68(12):2927-33
pubmed: 23825381
Infect Control Hosp Epidemiol. 2016 Apr;37(4):411-9
pubmed: 26880280
J Epidemiol Community Health. 2012 Oct;66(10):859-65
pubmed: 22859516