The Magnitude and Duration of Clostridium difficile Infection Risk Associated with Antibiotic Therapy: A Hospital Cohort Study

Antibiotic therapy is the principal risk factor for Clostridium difficile infection (CDI), but little is known about how risks cumulate over the course of therapy and abate after cessation. We prospectively identified CDI cases among adults hospitalized at a tertiary hospital between June 2010 and M...

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Bibliographic Details
Published in:PloS one Vol. 9; no. 8; p. e105454
Main Authors: Brown, Kevin A., Fisman, David N., Moineddin, Rahim, Daneman, Nick
Format: Journal Article
Language:English
Published: United States Public Library of Science 26.08.2014
Public Library of Science (PLoS)
Subjects:
Adult
Adults
Aged
Aged, 80 and over
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacteria
Biology and Life Sciences
Clostridium difficile
Clostridium difficile - isolation & purification
Clostridium Infections - epidemiology
Cohort analysis
Cohort Studies
Confidence intervals
Cross Infection - epidemiology
Diarrhea
Epidemiology
Female
Health aspects
Health risks
Health sciences
Health surveillance
Hospitals
Humans
Incidence
Infection
Infections
Infectious diseases
Male
Medical research
Medicine and Health Sciences
Middle Aged
Nosocomial infection
Nosocomial infections
Patients
Penicillin
Physical Sciences
Poisson density functions
Prospective Studies
Public health
Regression analysis
Regression models
Research and Analysis Methods
Risk Factors
Staphylococcus infections
Statistical analysis
Statistical methods
Studies
Survival analysis
Systematic review
Therapy
Toronto Ontario Canada
Canada
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:Antibiotic therapy is the principal risk factor for Clostridium difficile infection (CDI), but little is known about how risks cumulate over the course of therapy and abate after cessation. We prospectively identified CDI cases among adults hospitalized at a tertiary hospital between June 2010 and May 2012. Poisson regression models included covariates for time since admission, age, hospitalization history, disease pressure, and intensive care unit stay. Impacts of antibiotic use through time were modeled using 4 measures: current antibiotic receipt, time since most recent receipt, time since first receipt during a hospitalization, and duration of receipt. Over the 24-month study period, we identified 127 patients with new onset nosocomial CDI (incidence rate per 10,000 patient days [IR] = 5.86). Of the 4 measures, time since most recent receipt was the strongest independent predictor of CDI incidence. Relative to patients with no prior receipt of antibiotics in the last 30 days (IR = 2.95), the incidence rate of CDI was 2.41 times higher (95% confidence interval [CI] 1.41, 4.13) during antibiotic receipt and 2.16 times higher when patients had receipt in the prior 1-5 days (CI 1.17, 4.00). The incidence rates of CDI following 1-3, 4-6 and 7-11 days of antibiotic exposure were 1.60 (CI 0.85, 3.03), 2.27 (CI 1.24, 4.16) and 2.10 (CI 1.12, 3.94) times higher compared to no prior receipt. These findings are consistent with studies showing higher risk associated with longer antibiotic use in hospitalized patients, but suggest that the duration of increased risk is shorter than previously thought.
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Conceived and designed the experiments: KAB DNF RM ND. Performed the experiments: KAB ND. Analyzed the data: KAB DNF RM ND. Contributed reagents/materials/analysis tools: KAB RM. Wrote the paper: KAB DF ND. Drafted the manuscript: KAB ND. Critically revised the manuscript: DNF RM ND.
Competing Interests: The authors have read the journal's policy and have the following conflicts: Dr. Fisman has received research funding from Novartis, Sanofi-Pasteur, and GlaxoSmithKline vaccine divisions. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0105454