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Antibiotic Use and the Risk of Hospital-Onset Clostridioides Difficile Infection.

Mayan Gilboa1,2,3, Gili Regev-Yochay1,2,3, Eyal Meltzer1,4

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Clostridioides difficile carriers face a significantly higher risk of hospital-onset infection. Antibiotic use increases infection hazard in non-carriers but not in carriers, suggesting targeted prevention strategies are needed.

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Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Healthcare Management

Background:

  • Clostridioides difficile is a major cause of healthcare-associated infections.
  • Understanding the interplay between C. difficile carriage, antibiotic use, and infection risk is crucial for effective prevention strategies.

Purpose of the Study:

  • To assess the risk of C. difficile infection (CDI) in asymptomatic carriers versus non-carriers.
  • To determine if antibiotic exposure influences CDI hazard differently between carriers and non-carriers.

Main Methods:

  • Retrospective cohort study analyzing hospitalizations at Sheba Medical Center (June 2017-June 2023).
  • Included adult patients screened for C. difficile upon admission, excluding those with active CDI.
  • Assessed antibiotic exposure as a time-varying variable and CDI development as the primary outcome.

Main Results:

  • A positive C. difficile screen at admission was linked to a 27.5-fold increased hazard of CDI.
  • Antibiotic exposure increased CDI hazard (HR 1.98), with piperacillin-tazobactam showing the highest risk (HR 2.18).
  • Among carriers, antibiotic exposure did not significantly increase CDI hazard (HR 1.07).

Conclusions:

  • Asymptomatic C. difficile carriers have a substantially elevated baseline risk for hospital-onset CDI.
  • Antibiotic stewardship may mitigate CDI risk in non-carriers, but additional interventions are necessary for carriers due to their high baseline risk.