Cumulative Antibiotic Exposures Over Time and the Risk of Clostridium difficile Infection
Cumulative Antibiotic Exposures Over Time and the Risk of Clostridium difficile Infection
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DOI：
10.1093/cid/cir301
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发表时间：
2011-07-01
影响因子：
11.8
通讯作者：
van Wijngaarden, Edwin
中科院分区：
文献类型：
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作者：
Stevens, Vanessa;Dumyati, Ghinwa;van Wijngaarden, Edwin
背景艰难梭菌感染（CDI）是医院获得性腹泻的主要原因，最常见的是与抗生素给药引起的正常肠道植物群变化相关。很少有研究调查与抗生素总剂量、持续时间或数量相关的CDI风险，同时考虑到暴露随时间的复杂变化。2005年1月1日至12月31日在18岁或以上的住院患者中进行了一项回顾性队列研究，接受了2天或2天以上的治疗。该研究确定了7，792名独特患者的10，154次住院治疗和241例CDI病例，定义为C的检测。在出院后60天内的粪便样本中检测到艰难梭菌毒素。我们观察到与累积剂量、抗生素数量和抗生素暴露天数增加相关的CDI风险呈剂量依赖性增加。与仅接受1种抗生素的患者相比，接受2种、3种或4种或5种或更多种抗生素的患者的校正风险比（HR）分别为2.5（95%置信区间[CI] 1.6-4.0）、3.3（CI 2.2-5.2）和9.6（CI 6.1-15.1）。接受氟喹诺酮类药物与CDI风险增加相关，而甲硝唑与风险降低相关。累积抗生素暴露似乎与CDI的风险相关。抗菌药物管理计划侧重于总体减少总剂量以及抗生素暴露的数量和天数，并将高风险抗生素类别替换为低风险替代品，可能会降低医院获得性CDI的发生率。
Background. Clostridium difficile infection (CDI) is a major cause of hospital-acquired diarrhea and is most commonly associated with changes in normal intestinal flora caused by administration of antibiotics. Few studies have examined the risk of CDI associated with total dose, duration, or number of antibiotics while taking into account the complex changes in exposures over time.Methods. A retrospective cohort study conducted from 1 January to 31 December 2005 among hospitalized patients 18 years or older receiving 2 or more days of antibiotics.Results. The study identified 10,154 hospitalizations for 7,792 unique patients and 241 cases of CDI, defined as the detection of C. difficile toxin in a diarrheal stool sample within 60 days of discharge. We observed dose-dependent increases in the risk of CDI associated with increasing cumulative dose, number of antibiotics, and days of antibiotic exposure. Compared to patients who received only 1 antibiotic, the adjusted hazard ratios (HRs) for those who received 2, 3 or 4, or 5 or more antibiotics were 2.5 (95% confidence interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), and 9.6 (CI 6.1-15.1), respectively. The receipt of fluoroquinolones was associated with an increased risk of CDI, while metronidazole was associated with reduced risk.Conclusions. Cumulative antibiotic exposures appear to be associated with the risk of CDI. Antimicrobial stewardship programs that focus on the overall reduction of total dose as well as number and days of antibiotic exposure and the substitution of high-risk antibiotic classes for lower-risk alternatives may reduce the incidence of hospital-acquired CDI.