Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection

The rising incidence of Clostridium difficile infection (CDI) could be reduced by lowering exposure to high-risk antibiotics. The objective of this study was to determine the association between antibiotic class and the risk of CDI in the community setting. The EMBASE and PubMed databases were queri...

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Veröffentlicht in:Antimicrobial agents and chemotherapy Jg. 57; H. 5; S. 2326
Hauptverfasser: Brown, Kevin A, Khanafer, Nagham, Daneman, Nick, Fisman, David N
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.05.2013
Schlagworte:
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - classification
Clostridium difficile - drug effects
Clostridium difficile - physiology
Community-Acquired Infections - drug therapy
Community-Acquired Infections - epidemiology
Community-Acquired Infections - etiology
Community-Acquired Infections - microbiology
Databases, Bibliographic
Enterocolitis, Pseudomembranous - drug therapy
Enterocolitis, Pseudomembranous - epidemiology
Enterocolitis, Pseudomembranous - etiology
Enterocolitis, Pseudomembranous - microbiology
Humans
Odds Ratio
Randomized Controlled Trials as Topic
Risk Assessment
ISSN:1098-6596, 1098-6596
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Zusammenfassung:The rising incidence of Clostridium difficile infection (CDI) could be reduced by lowering exposure to high-risk antibiotics. The objective of this study was to determine the association between antibiotic class and the risk of CDI in the community setting. The EMBASE and PubMed databases were queried without restriction to time period or language. Comparative observational studies and randomized controlled trials (RCTs) considering the impact of exposure to antibiotics on CDI risk among nonhospitalized populations were considered. We estimated pooled odds ratios (OR) for antibiotic classes using random-effect meta-analysis. Our search criteria identified 465 articles, of which 7 met inclusion criteria; all were observational studies. Five studies considered antibiotic risk relative to no antibiotic exposure: clindamycin (OR = 16.80; 95% confidence interval [95% CI], 7.48 to 37.76), fluoroquinolones (OR = 5.50; 95% CI, 4.26 to 7.11), and cephalosporins, monobactams, and carbapenems (CMCs) (OR = 5.68; 95% CI, 2.12 to 15.23) had the largest effects, while macrolides (OR = 2.65; 95% CI, 1.92 to 3.64), sulfonamides and trimethoprim (OR = 1.81; 95% CI, 1.34 to 2.43), and penicillins (OR = 2.71; 95% CI, 1.75 to 4.21) had lower associations with CDI. We noted no effect of tetracyclines on CDI risk (OR = 0.92; 95% CI, 0.61 to 1.40). In the community setting, there is substantial variation in the risk of CDI associated with different antimicrobial classes. Avoidance of high-risk antibiotics (such as clindamycin, CMCs, and fluoroquinolones) in favor of lower-risk antibiotics (such as penicillins, macrolides, and tetracyclines) may help reduce the incidence of CDI.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1098-6596
1098-6596
DOI:10.1128/AAC.02176-12