Antibiotic and Nonantibiotic Drugs Associated With Clostridioides difficile Infection Risk: a Pharmacopoeia-Wide...

Area of Science:

• Infectious Diseases
• Pharmacology
• Microbiology

Background:

• Clostridioides difficile infection (CDI) is primarily caused by antibiotic use disrupting gut bacteria.
• The role of nonantibiotic medications in CDI development is not well understood.

Purpose of the Study:

• To investigate the contribution of both antibiotic and nonantibiotic drugs to CDI risk in older adults.
• To identify specific drugs associated with increased or decreased CDI risk.

Main Methods:

• A case-cohort study design was employed, analyzing data from 2018-2023.
• Logistic regression models assessed drug exposures in the 90 days prior to CDI diagnosis.
• Covariates included age, sex, comorbidities, and healthcare exposures.

Main Results:

• Amoxicillin-clavulanate, clindamycin, ciprofloxacin, and cephalexin were major contributors to CDI risk.
• Nonantibiotic drugs pantoprazole and ferrous fumarate also increased CDI risk.
• Metformin demonstrated a protective association against CDI.

Conclusions:

• This research highlights key drug-related factors influencing CDI etiology.
• Findings offer potential strategies for antimicrobial stewardship and drug repurposing to combat CDI.