Community-associated Clostridium difficile infection and antibiotics: a meta-analysis
Community-associated Clostridium difficile infection and antibiotics: a meta-analysis
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DOI：
10.1093/jac/dkt129
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发表时间：
2013-09-01
影响因子：
5.2
通讯作者：
Donskey, Curtis J.
中科院分区：
文献类型：
--
作者：
Deshpande, Abhishek;Pasupuleti, Vinay;Donskey, Curtis J.
抗生素暴露是艰难梭菌感染(CDI)最重要的危险因素。大多数抗菌素风险因素的评估都是在医疗保健环境中进行的。这项Meta分析的目的是评估抗生素暴露与社区相关CDI(CA-CDI)(即12周内没有医疗机构入院的社区症状出现)之间的关系，并确定构成最大风险的抗生素类别。我们在4个电子数据库中搜索与CA-CDI和抗生素相关的主题和文本词。调查与抗生素使用相关的CA-CDI风险的研究被认为是合格的。使用随机效应模型结合已确定研究的数据并计算OR。在已确定的910项引用中，有8项研究(N30184名患者)符合我们的纳入标准。抗生素暴露与CA-CDI风险增加相关(OR 6.91，95 CI 4.1711.44，I(2)95)。其次是氟喹诺酮类(OR 5.65，95 CI 4.387.28)、头孢菌素类(OR 4.47，95 CI 1.6012.50)、青霉素类(OR 3.25，95 CI 1.895.57)、大环内酯类(OR 2.55，95 CI 1.913.39)和磺胺类/甲氧苄啶(OR 1.84，95 CI 1.482.29)。四环素类药物与CDI风险增加无关(OR 0.91，95 CI 0.571.45)。抗生素暴露是CA-CDI的重要危险因素，但不同抗生素类别的风险不同。克林霉素的风险最大，其次是氟喹诺酮类和头孢菌素类，而四环素类药物与风险增加无关。
Antibiotic exposure is the most important risk factor for Clostridium difficile infection (CDI). Most evaluations of antimicrobial risk factors have been conducted in healthcare settings. The objective of this meta-analysis was to evaluate the association between antibiotic exposure and community-associated CDI (CA-CDI) (i.e. symptom onset in the community with no healthcare facility admission within 12 weeks) and to determine the classes of antibiotics posing the greatest risk.We searched four electronic databases for subject headings and text words related to CA-CDI and antibiotics. Studies that investigated the risk of CA-CDI associated with antibiotic usage were considered eligible. Data from the identified studies were combined using a random-effects model and ORs were calculated.Of 910 citations identified, eight studies (n30184 patients) met our inclusion criteria. Antibiotic exposure was associated with an increased risk of CA-CDI (OR 6.91, 95 CI 4.1711.44, I(2)95). The risk was greatest with clindamycin (OR 20.43, 95 CI 8.5049.09) followed by fluoroquinolones (OR 5.65, 95 CI 4.387.28), cephalosporins (OR 4.47, 95 CI 1.6012.50), penicillins (OR 3.25, 95 CI 1.895.57), macrolides (OR 2.55, 95 CI 1.913.39) and sulphonamides/trimethoprim (OR 1.84, 95 CI 1.482.29). Tetracyclines were not associated with an increased CDI risk (OR 0.91, 95 CI 0.571.45).Antibiotic exposure was an important risk factor for CA-CDI, but the risk was different amongst different antibiotic classes. The risk was greatest with clindamycin followed by fluoroquinolones and cephalosporins, whereas tetracyclines were not associated with an increased risk.