Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Western Australia.
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia.
J Antimicrob Chemother. 2021 Jun 18;76(7):1676-1688. doi: 10.1093/jac/dkab091.
Antibiotic use is the most important modifiable risk factor for healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). Previous systematic reviews cover studies published until 31 December 2012.
To update the evidence for associations between antibiotic classes and HCFA-CDI to 31 December 2020.
PubMed, Scopus, Web of Science Core Collection, WorldCat and Proquest Dissertations & Theses were searched for studies published since 1 January 2013. Eligible studies were those conducted among adult hospital inpatients, measured exposure to individual antibiotics or antibiotic classes, included a comparison group and measured the occurrence of HCFA-CDI as an outcome. The Newcastle-Ottawa Scale was used to appraise study quality. To assess the association between each antibiotic class and HCFA-CDI, a pooled random-effects meta-analysis was undertaken. Meta-regression and subgroup analysis was used to investigate study characteristics identified a priori as potential sources of heterogeneity.
Carbapenems and third- and fourth-generation cephalosporin antibiotics remain the most strongly associated with HCFA-CDI, with cases more than twice as likely to have recent exposure to these antibiotics prior to developing HCFA-CDI. Modest associations were observed for fluoroquinolones, clindamycin and β-lactamase inhibitor combination penicillin antibiotics. Individual study effect sizes were variable and heterogeneity was observed for most antibiotic classes.
This review provides the most up-to-date synthesis of evidence in relation to the risk of HCFA-CDI associated with exposure to specific antibiotic classes. Studies were predominantly conducted in North America or Europe and more studies outside of these settings are needed.
抗生素的使用是医疗机构相关艰难梭菌感染（HCFA-CDI）最重要的可改变的危险因素。先前的系统综述涵盖了截至 2012 年 12 月 31 日发表的研究。
更新抗生素类别与 HCFA-CDI 之间关联的证据，截至 2020 年 12 月 31 日。
在 PubMed、Scopus、Web of Science Core Collection、WorldCat 和 ProQuest Dissertations & Theses 中搜索了自 2013 年 1 月 1 日以来发表的研究。合格的研究是在成年住院患者中进行的，测量了对单个抗生素或抗生素类别的暴露，包括对照组，并将 HCFA-CDI 的发生作为结果进行测量。使用 Newcastle-Ottawa 量表评估研究质量。为了评估每个抗生素类别与 HCFA-CDI 之间的关联，进行了汇总随机效应荟萃分析。使用元回归和亚组分析来研究预先确定的可能导致异质性的研究特征。
碳青霉烯类和第三代和第四代头孢菌素类抗生素仍然与 HCFA-CDI 关联最强，与发生 HCFA-CDI 之前最近接触这些抗生素的病例的可能性是两倍以上。氟喹诺酮类、克林霉素和β-内酰胺酶抑制剂联合青霉素类抗生素也观察到了适度的关联。个别研究的效应量各不相同，大多数抗生素类别的异质性也很明显。
本综述提供了与暴露于特定抗生素类别相关的 HCFA-CDI 风险的最新综合证据。这些研究主要在北美或欧洲进行，需要在这些环境之外进行更多的研究。
