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Case-Control Study of Antibiotic Use and Subsequent Clostridium difficile–Associated Diarrhea in Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015

Roger Baxter ,
G. Thomas Ray  and
Bruce H. Fireman
Roger Baxter*
Affiliation:
Permanente Medical Group, Oakland, California
G. Thomas Ray
Affiliation:
Division of Research, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, California
Bruce H. Fireman
Affiliation:
Permanente Medical Group, Oakland, California
*
Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, Ordway Bldg., 16th Floor, Oakland, CA 94612 (roger.baxter@kp.org)
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Abstract

Objective.

To determine which antibiotics increase or decrease the risk of Clostridium difficile-associated diarrhea (CDAD).

Design.

Retrospective case-control study.

Setting.

Nonprofit, integrated healthcare delivery system in Northern California.

Patients.

Study participants included patients with cases of hospital-acquired CDAD that occurred during the period from 1999 through 2005 (n = 1,142) and control patients (n = 3,351) matched for facility, calendar quarter during which hospitalization occurred, diagnosis related group for the index hospitalization, and length of hospital stay. All case and control patients had received antibiotics in the 60 days before the index date. For each antibiotic, the risk of CDAD was examined in relation to whether the patient received the antibiotic, after adjustment for use of other antibiotics, demographic characteristics, selected health conditions, and use of healthcare services.

Results.

The following antibiotics were associated with a significantly increased risk of acquiring CDAD: imipenem-cilastin (odds ratio [OR], 2.77), clindamycin (OR, 2.31), cefuroxime (OR, 2.16), moxifloxacin (OR, 1.88), ceftazidime (OR, 1.82), cefpodoxime (OR, 1.58), ceftizoxime (OR, 1.57), and ceftriaxone (OR, 1.49). Metronidazole and doxycycline were associated with a significantly reduced risk of CDAD (OR for metronidazole, 0.67; OR for doxycycline, 0.41). Other factors associated with an increased risk of CDAD were older age, longer hospital stays, use of proton pump inhibitors, prior gastrointestinal disease, and prior infection (not including C. difficile infection.)

Conclusions.

Some antibiotics appear to increase the risk of acquiring CDAD, notably clindamycin, third-generation cephalosporins, and carbapenems, whereas metronidazole and doxycycline appear to be protective, compared with other antibiotics.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 44 - 50
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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