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Do piperacillin/tazobactam and other antibiotics with inhibitory activity against Clostridium difficile reduce the

Sirisha Kundrapu1,2, Venkata C K Sunkesula1, Lucy A Jury3

  • 1Department of Medicine, Infectious Diseases Division, Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA.

BMC Infectious Diseases
|April 20, 2016
PubMed
Abstract

Insights

Piperacillin-tazobactam effectively inhibits Clostridium difficile colonization in patients by achieving adequate intestinal concentrations. This finding is crucial for understanding antibiotic impact on gut microbiota and preventing C. difficile infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Systemic antibiotics exhibit variable in vitro activity against Clostridium difficile.
  • Some antibiotics active against C. difficile, like piperacillin-tazobactam, can prevent colonization in mouse models.
  • The hypothesis tested was whether piperacillin-tazobactam and similar agents reach sufficient intestinal concentrations to inhibit C. difficile colonization in humans.

Purpose of the Study:

  • To evaluate the effectiveness of piperacillin-tazobactam in preventing Clostridium difficile colonization in patients.
  • To compare the rates of asymptomatic C. difficile carriage among patients receiving different classes of antibiotics.
  • To assess the in vitro inhibitory activity of fecal samples from patients on various antibiotic regimens against C. difficile.

Main Methods:

  • Point-prevalence surveys were used to determine the frequency of asymptomatic rectal carriage of toxigenic C. difficile.
  • Patients were categorized based on current antibiotic use: piperacillin-tazobactam, other inhibitory antibiotics, or non-inhibitory antibiotics.
  • In vitro inhibition of C. difficile in fecal suspensions was measured for a subset of patients across different antibiotic groups.

Main Results:

  • Asymptomatic C. difficile carriage was significantly lower in patients receiving piperacillin-tazobactam (3%) compared to those on non-inhibitory (22%) or prior antibiotics (19%).
  • Fecal samples from patients on piperacillin-tazobactam demonstrated significantly higher in vitro inhibitory activity against C. difficile (71%) than other groups (27% and 15%).
  • Other antibiotics with in vitro activity against C. difficile did not show a significant reduction in asymptomatic carriage rates compared to non-inhibitory antibiotics.

Conclusions:

  • Piperacillin-tazobactam therapy leads to sufficient intestinal concentrations to inhibit Clostridium difficile colonization.
  • The findings support the role of piperacillin-tazobactam in preventing C. difficile colonization during treatment.
  • Antibiotic selection is critical in managing the risk of C. difficile colonization and subsequent infection.
Keywords:
Clostridium difficileColonizationPiperacillin/tazobactam

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