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Updated: Aug 18, 2025

A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Risk of antibiotics associated with Clostridioides difficile infection: Antibiotic stewardship in action

Andrew T Dysangco1,2,3,4, Tamra M Pierce5, Dawn M Bravata1,2,3,4,6,7

  • 1Department of Veterans' Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana.

Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
|December 9, 2022
PubMed

Insights

This study investigated antibiotic risks for Clostridioides difficile infection (CDI). Intravenous meropenem and oral metronidazole showed the highest associated CDI rates in inpatient and outpatient settings, respectively.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Microbiology

Background:

  • Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
  • Antibiotic use is a primary risk factor for CDI development and recurrence.
  • Understanding specific antibiotic risks is crucial for infection prevention strategies.

Purpose of the Study:

  • To assess the risk of CDI associated with specific inpatient and outpatient antibiotic agents.
  • To identify antibiotics with the highest CDI incidence rates at a single institution.

Main Methods:

  • Retrospective analysis of CDI cases and antibiotic utilization data from 2018-2020.
  • Calculation of CDI rates per 1,000 days of therapy for inpatient antibiotics.
  • Calculation of CDI rates per 1,000 pills dispensed for outpatient antibiotics.

Main Results:

  • A total of 78 patients with nonrecurrent CDI were analyzed.
  • Intravenous meropenem exhibited the highest inpatient CDI rate (3.56 per 1,000 days of therapy).
  • Metronidazole demonstrated the highest outpatient CDI rate (0.071 per 1,000 pills dispensed).

Conclusions:

  • Certain antibiotics, including intravenous meropenem and oral metronidazole, are associated with higher CDI risks.
  • These findings can inform antibiotic stewardship and CDI prevention efforts.
  • Further research is warranted to explore causative mechanisms and refine treatment guidelines.

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