Antibiotic exposure and the risk of hospital-acquired diarrhoea and Clostridioides difficile infection: a cohort study.
Journal
The Journal of antimicrobial chemotherapy
ISSN: 1460-2091
Titre abrégé: J Antimicrob Chemother
Pays: England
ID NLM: 7513617
Informations de publication
Date de publication:
15 07 2021
15 07 2021
Historique:
received:
21
01
2021
accepted:
18
04
2021
pubmed:
11
5
2021
medline:
11
8
2021
entrez:
10
5
2021
Statut:
ppublish
Résumé
Hospital-acquired diarrhoea (HAD) and Clostridioides difficile infection (CDI) may be triggered by antibiotic use. To determine the effect of specific antibiotic agents and duration of therapy on the risk of HAD and CDI. A single-centre retrospective cohort study was conducted between May 2012 and December 2014 in the internal medicine division. HAD was defined based on documentation of diarrhoea in the medical record or an uncancelled C. difficile test in the laboratory database. CDI was diagnosed using a two-step test (initial glutamate dehydrogenase and toxin A/B EIA, with PCR for discrepant results). Outcomes first occurred on hospital Day 4 or later. Treatment with antibiotics and days of therapy were modelled. In 29 063 hospitalizations there were 970 HAD events [incidence rate per 10 000 patient days (IR) = 38.5] and 105 CDI events (IR = 3.9). Any antibiotic treatment increased the risk of HAD [adjusted relative risk (aRR) 2.79; 95% CI 2.27-3.43] and CDI (aRR 5.31; 95% CI 2.23-12.69). Each day of β-lactam/β-lactamase inhibitors (βL/βLIs), carbapenems, IV glycopeptides and metronidazole increased the risk of HAD. Each day of βL/βLIs, third- and fourth-generation cephalosporins and carbapenems increased the risk of CDI by over 2%. Preventing HAD and CDI should focus on reducing the overall use of antibiotics and shortening antibiotic exposure, rather than focusing on specific agents.
Sections du résumé
BACKGROUND
Hospital-acquired diarrhoea (HAD) and Clostridioides difficile infection (CDI) may be triggered by antibiotic use.
OBJECTIVES
To determine the effect of specific antibiotic agents and duration of therapy on the risk of HAD and CDI.
PATIENTS AND METHODS
A single-centre retrospective cohort study was conducted between May 2012 and December 2014 in the internal medicine division. HAD was defined based on documentation of diarrhoea in the medical record or an uncancelled C. difficile test in the laboratory database. CDI was diagnosed using a two-step test (initial glutamate dehydrogenase and toxin A/B EIA, with PCR for discrepant results). Outcomes first occurred on hospital Day 4 or later. Treatment with antibiotics and days of therapy were modelled.
RESULTS
In 29 063 hospitalizations there were 970 HAD events [incidence rate per 10 000 patient days (IR) = 38.5] and 105 CDI events (IR = 3.9). Any antibiotic treatment increased the risk of HAD [adjusted relative risk (aRR) 2.79; 95% CI 2.27-3.43] and CDI (aRR 5.31; 95% CI 2.23-12.69). Each day of β-lactam/β-lactamase inhibitors (βL/βLIs), carbapenems, IV glycopeptides and metronidazole increased the risk of HAD. Each day of βL/βLIs, third- and fourth-generation cephalosporins and carbapenems increased the risk of CDI by over 2%.
CONCLUSIONS
Preventing HAD and CDI should focus on reducing the overall use of antibiotics and shortening antibiotic exposure, rather than focusing on specific agents.
Identifiants
pubmed: 33969419
pii: 6272918
doi: 10.1093/jac/dkab151
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2182-2185Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.