Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Antimicrob Chemother. 2021 Jul 15;76(8):2182-2185. doi: 10.1093/jac/dkab151.
Hospital-acquired diarrhoea (HAD) and Clostridioides difficile infection (CDI) may be triggered by antibiotic use.
To determine the effect of specific antibiotic agents and duration of therapy on the risk of HAD and CDI.
A single-centre retrospective cohort study was conducted between May 2012 and December 2014 in the internal medicine division. HAD was defined based on documentation of diarrhoea in the medical record or an uncancelled C. difficile test in the laboratory database. CDI was diagnosed using a two-step test (initial glutamate dehydrogenase and toxin A/B EIA, with PCR for discrepant results). Outcomes first occurred on hospital Day 4 or later. Treatment with antibiotics and days of therapy were modelled.
In 29 063 hospitalizations there were 970 HAD events [incidence rate per 10 000 patient days (IR) = 38.5] and 105 CDI events (IR = 3.9). Any antibiotic treatment increased the risk of HAD [adjusted relative risk (aRR) 2.79; 95% CI 2.27-3.43] and CDI (aRR 5.31; 95% CI 2.23-12.69). Each day of β-lactam/β-lactamase inhibitors (βL/βLIs), carbapenems, IV glycopeptides and metronidazole increased the risk of HAD. Each day of βL/βLIs, third- and fourth-generation cephalosporins and carbapenems increased the risk of CDI by over 2%.
Preventing HAD and CDI should focus on reducing the overall use of antibiotics and shortening antibiotic exposure, rather than focusing on specific agents.
医院获得性腹泻（HAD）和艰难梭菌感染（CDI）可能由抗生素使用引发。
确定特定抗生素药物和治疗持续时间对 HAD 和 CDI 风险的影响。
这是一项 2012 年 5 月至 2014 年 12 月在内科进行的单中心回顾性队列研究。HAD 的定义是病历中记录有腹泻或实验室数据库中未取消的艰难梭菌检测。CDI 采用两步法检测（初始谷氨酸脱氢酶和毒素 A/B EIA，对结果不一致者进行 PCR）诊断。住院第 4 天或之后首次出现结局。对抗生素治疗和治疗天数进行建模。
在 29063 例住院患者中，有 970 例 HAD 事件（发病率为每 10000 个患者日 38.5）和 105 例 CDI 事件（发病率为 3.9）。任何抗生素治疗都会增加 HAD 的风险（校正相对风险[aRR] 2.79；95%CI 2.27-3.43）和 CDI（aRR 5.31；95%CI 2.23-12.69）。β-内酰胺/β-内酰胺酶抑制剂（βL/βLIs）、碳青霉烯类、静脉用糖肽类和甲硝唑的每增加一天，都会增加 HAD 的风险。βL/βLIs、三代和四代头孢菌素和碳青霉烯类的每增加一天，都会使 CDI 的风险增加 2%以上。
预防 HAD 和 CDI 应重点减少抗生素的总体使用量并缩短抗生素暴露时间，而不是侧重于特定药物。
