Open Access2388. High-risk antibiotics associated with Clostridioides difficile infection: a national, multicenter analysis
Author(s) -
Eric H Young,
Amina R Zeidan,
Kevin W. Garey,
Kelly R. Reveles
Publication year - 2019
Publication title -
open forum infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.546
H-Index - 35
ISSN - 2328-8957
DOI - 10.1093/ofid/ofz360.2066
Subject(s) - medicine , clindamycin , antibiotics , cephalosporin , logistic regression , population , vancomycin , microbiology and biotechnology , environmental health , genetics , bacteria , staphylococcus aureus , biology
Background Historically, antibiotics with the highest Clostridioides difficile infection (CDI) risk included clindamycin, advanced-spectrum penicillins, and cephalosporins; however, a recent CDI epidemic involving fluoroquinolone (FQ)-resistant ribotype 027-added FQs as a high-risk class. Now that the ribotype 027 strain is part of an endemic population of C. difficile strains, no contemporary analysis of high-risk antibiotics and CDI risk has been conducted. The primary objective of this study was to identify the strongest antibiotic predictors for CDI. Methods This was a case–control study in the national United States Veterans Health Administration (VHA). The study included patients 18–89 years old with an ICD-9-CM code for CDI (008.45), a positive stool test, and active CDI therapy between 2002 and 2014. A random sample of VHA patients without a CDI ICD-9-CM code served as the control cohort. Antibiotic use was defined as any use in the 90 days prior to inclusion. Antibiotic risk factors for CDI were evaluated in a multivariable logistic regression model that included 33 covariates. Results were validated in non-VA patients at a quaternary care medical center in Houston, TX. Results A total of 85,451 VHA patients were included (26,149 CDI patients and 59,302 controls). FQs were most commonly prescribed: 24.9% (CDI group) and 7.3% (controls). Strongest predictors of CDI included carbapenems (OR 54.39, 95% CI 25.42–116.36), advanced-spectrum penicillins (OR 41.54; 95% CI 31.49–54.78), third/fourth-generation cephalosporins (OR 17.35; 95% CI 14.49–20.77), clindamycin (OR 3.63; 95% CI 3.26–4.02), and FQs (OR 1.48; 95% CI 1.40–1.57). Macrolides (OR 0.83; 95% CI 0.77–0.91) and tetracyclines (OR 0.58; 95 CI 0.51–0.66) were negatively associated with CDI risk. In a validation cohort of 68,795 patients, carbapenems (OR 2.19; 95% CI 1.86–2.57), third/fourth-generation cephalosporins (OR 1.70; 95% CI 1.50–1.93), and advanced-spectrum penicillins (OR 1.64; 95% CI 1.42–1.89) were also the strongest predictors for CDI. FQs were not significantly associated with CDI. Conclusion Although FQs were the most prescribed antibiotic class, carbapenems were the strongest predictor of CDI development in a national cohort of veterans and a validation cohort. Disclosures All authors: No reported disclosures.