TYPE OF ANTIBIOTIC AND CLOSTRIDIUM DIFFICILE RISK

NEW YORK (Reuters Health) Dec 27 - The risk of hospital-acquired Clostridium difficile infection (HA-CDI) is greatest for cephalosporins and clindamycin, researchers from Australia have found.

Their study, online December 8 in the Journal of Antimicrobial Chemotherapy, updates a systematic review with data up to 2001 that came to a similar conclusion.

The increasing rates of CDI in industrialized countries and the emergence of the NAP1/RT027 strain in North America and Europe prompted Dr. Claudia Slimings and Dr. Thomas V. Riley from The University of Western Australia in Crowley to reevaluate the associations between antibiotic classes and the risk of HA-CDI from January 2002 to December 2012.

Their review included 14 studies (13 case-control studies and 1 cohort study) covering nearly 16,000 patients. Overall, antibiotic exposure was associated with a 60% increased risk of CDI. The strongest associations were seen for third-generation cephalosporins (odds ratio, 3.20), clindamycin (OR, 2.86), second-generation cephalosporins (OR, 2.23), fourth-generation cephalosporins (OR, 2.14), carbapenems (OR, 1.84), trimethoprim/sulphonamides (OR, 1.78), fluoroquinolones (OR, 1.66) and penicillin combinations (OR, 1.45).

Aminoglycosides, tetracylines, and macrolides were not associated with an increased risk of CDI.

In the only cohort study (about 8,000 adult inpatients), fluoroquinolones, third-/fourth-generation cephalosporins, beta-lactamase inhibitor combination penicillins, and trimethoprim/sulfonamides were most strongly associated with an increased risk of CDI.

"The findings indicate that third-generation cephalosporins remain the strongest antibiotic risk factor," the researchers conclude. "The modest association seen for fluoroquinolone antibiotics is not surprising, as they are more specifically related to C. difficile infections with the NAP1/RT027 fluoroquinolone-resistant epidemic strain."

"This study provides the most up-to-date and systematic synthesis of the literature in relation to the risk of HA-CDI associated with antibiotics," they add. "However, the results should be interpreted with caution as the number of studies contributing to any one analysis ranged from three to 10."

Dr. Slimings did not respond to a request for comments.

SOURCE: http://bit.ly/JwTxIj

J Antimicrob Chemother 2013.