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Comparison of different antibiotics and the risk for community-associated clostridioides difficile infection: a case-control study
Journal article   Open access   Peer reviewed

Comparison of different antibiotics and the risk for community-associated clostridioides difficile infection: a case-control study

Aaron C Miller, Alan T Arakkal, Daniel K Sewell, Alberto M Segre, Joseph Tholany, Philip M Polgreen and CDC MInD-Healthcare Group
Open forum infectious diseases, Vol.10(8), ofad413
08/05/2023
DOI: 10.1093/ofid/ofad413
PMCID: PMC10444966
PMID: 37622034
url
https://doi.org/10.1093/ofid/ofad413View
Published (Version of record) Open Access

Abstract

Abstract Background Antibiotics are the greatest risk factor for clostridioides difficile infection (CDI). Risk for CDI varies across antibiotic types and classes. Optimal prescribing and stewardship recommendations require comparisons of risk across antibiotics. However, many prior studies rely on aggregated antibiotic categories or are underpowered to detect significant differences across antibiotic types. Using a large database of real-world data, we evaluate community-associated CDI risk across individual antibiotic types. Methods We conducted a matched case-control study using a large database of insurance claims capturing longitudinal healthcare encounters and medications. Case patients with community-associated CDI were matched to 5 control patients by age, sex, and enrollment period. Antibiotics prescribed within 30 days prior to the CDI diagnosis along with other risk factors, including comorbidities, healthcare exposures, and gastric acid suppression were considered. Conditional logistic regression and a Bayesian analysis were used to compare risk across individual antibiotics. A sensitivity analysis of antibiotic exposure windows between 30-180 days was conducted. Results We identified 159,404 cases and 797,020 controls. Antibiotics with the greatest risk for CDI included clindamycin and later-generation cephalosporins and those with the lowest risk included minocycline and doxycycline. We were able to differentiate and order individual antibiotics in terms of their relative level of associated risk for CDI. Risk estimates varied considerably with different exposure windows considered. Conclusions We found wide variation in CDI risk within and between classes of antibiotics. These findings ordering the level of associated risk across antibiotics can help inform tradeoffs in antibiotic prescribing decisions and stewardship efforts.

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