Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Internal Medicine-Infectious Diseases, IASO General Hospital, IASO Group, Athens, Greece.
Alfa Institute of Biomedical Sciences, Athens, Greece.
Int J Antimicrob Agents. 2016 Jul;48(1):1-10. doi: 10.1016/j.ijantimicag.2016.03.008. Epub 2016 Apr 27.
Antibiotics have been the most important risk factor for Clostridium difficile infection (CDI). However, only data from non-randomised studies have been reviewed. We sought to evaluate the risk for development of CDI associated with the major antibiotic classes by analysing data from randomised controlled trials (RCTs). The PubMed, Cochrane and Scopus databases were searched and the references of selected RCTs were also hand-searched. Eligible studies should have compared only one antibiotic versus another administered systemically. Inclusion of studies comparing combinations of antibiotics was allowed only if the second antibiotic was the same or from the same class or if it was administered in a subset of the enrolled patients who were equally distributed in the two arms. Only a minority of the selected RCTs (79/1332; 5.9%) reported CDI episodes. Carbapenems were associated with more CDI episodes than fluoroquinolones [risk ratio (RR) = 2.44, 95% confidence interval (CI) 1.32-4.49] and cephalosporins (RR = 2.24, 95% CI 1.46-3.42), but not penicillins (RR = 2.53, 95% CI 0.87-7.41). Cephalosporins were associated with more CDIs than penicillins (RR = 2.36, 95% CI 1.32-4.23) and fluoroquinolones (RR = 2.84, 95% CI 1.60-5.06). There was no difference in CDI frequency between fluoroquinolones and penicillins (RR = 1.34, 95% CI 0.55-3.25). Finally, clindamycin was associated with more CDI episodes than cephalosporins and penicillins (RR = 3.92, 95% CI 1.15-13.43). In conclusion, data from RCTs showed that clindamycin and carbapenems were associated with more CDIs than other antibiotics.
抗生素一直是艰难梭菌感染（CDI）的最重要危险因素。然而，目前仅对非随机研究的数据进行了审查。我们试图通过分析随机对照试验（RCT）的数据来评估与主要抗生素类别相关的 CDI 发展风险。检索了 PubMed、Cochrane 和 Scopus 数据库，并对入选 RCT 的参考文献进行了手工检索。合格的研究应仅比较一种抗生素与另一种全身给药的抗生素。只有在第二个抗生素相同或来自同一类别，或者它在两个臂中均分布的相同数量的入组患者中给药时，才允许纳入比较抗生素联合治疗的研究。只有少数入选 RCT（79/1332；5.9%）报告了 CDI 发作。碳青霉烯类抗生素比氟喹诺酮类抗生素（RR=2.44，95%置信区间（CI）1.32-4.49）和头孢菌素类抗生素（RR=2.24，95%CI 1.46-3.42）更易导致 CDI 发作，但与青霉素类抗生素（RR=2.53，95%CI 0.87-7.41）无差异。头孢菌素类抗生素比青霉素类抗生素（RR=2.36，95%CI 1.32-4.23）和氟喹诺酮类抗生素（RR=2.84，95%CI 1.60-5.06）更易导致 CDI 发作。氟喹诺酮类抗生素和青霉素类抗生素的 CDI 发生率无差异（RR=1.34，95%CI 0.55-3.25）。最后，克林霉素比头孢菌素类抗生素和青霉素类抗生素更容易导致 CDI 发作（RR=3.92，95%CI 1.15-13.43）。总之，RCT 数据表明，克林霉素和碳青霉烯类抗生素比其他抗生素更容易导致 CDI。
