Antibiotic use and duration in association with Clostridioides difficile infection in a tertiary academic medical...

Previous literature has attributed the use of certain antibiotics to Clostridioides difficile infection (CDI); however, the time from administration to CDI onset is not adequately evaluated. We aimed to determine the type of antibiotics and duration of therapy associated with the highest CDI incidence at a tertiary academic medical center. This was a retrospective, case-control study of adult inpatients who received at least one course of antibiotic treatment. Patients were divided into either cases or controls. For cases, their first episode of CDI was a determining factor. Primary outcome were the types of antibiotics associated with risk of CDI development and the median time of antibiotic usage defining this risk. Of 601 patients who developed CDI, 313 were included as cases while 150 of 291 who received antibiotics but did not develop CDI were included as controls. Cefepime and cefazolin were significantly associated with increased risk for CDI with odds ratios of 3.01 (95% CI, 1.96-4.65; P < 0.001) and 1.71 (95% CI, 1.02-2.95; P < 0.05), respectively. Cefepime was associated with CDI after a median time of 8 days while CDI may have occurred after 6 days of therapy with cefazolin. Use of antineoplastic agents was significantly associated with CDI (odds ratio, 2.32; 95% CI, 1.35-4.13; P < 0.01). Antibiotic use increased the risk of CDI, particularly with cefepime and cefazolin with a median time to incidence of 8 and 6 days, respectively. CDI risk was also increased with the use of antineoplastic agents.