[Source: Antimicrobial Agents and Chemotherapy, full text: (LINK). Abstract, edited.]
Antibiotics and the risk of community-associated Clostridium difficile infection (CDI): a meta-analysis

Kevin A. Brown a, Nagham Khanafer b, Nick Daneman c and David N. Fisman a

Author Affiliations: <SUP>a</SUP>Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Canada <SUP>b</SUP>Laboratoire de Biom?trie et de Biologie ?volutive, Universit? de Lyon, France <SUP>c</SUP>Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada


The rising incidence of Clostridium difficile infection (CDI) could be reduced by lowering exposures to high risk antibiotics. The objective of this study was to determine the association between antibiotic class and the risk of CDI in the community setting. EMBASE and PubMed were queried without restriction to date or language. Comparative observational studies and RCTs considering the impact of antibiotic exposures on CDI risk among non-hospitalized populations were considered. We estimated pooled odds ratios (OR) for antibiotic classes using random effects meta-analysis. Our search criteria identified 465 articles, of which 7 met inclusion criteria; all were observational studies. Five studies considered antibiotic risk relative to no antibiotic exposure: clindamycin (OR=16.80, 95% confidence interval [CI]: 7.48?37.76), fluoroquinolones (OR=5.50, 95% CI: 4.26?7.11) and cephalosporins, monobactams and carbapenems (CMCs, OR=5.68, 95% CI: 2.12?15.23) had the largest effects, while macrolides (OR=2.65, 95% CI: 1.92?3.64), sulfonamides and trimethoprim (OR=1.81, 95% CI: 1.34?2.43) and penicillins (OR=2.71, 95% CI: 1.75?4.21) had lesser associations with CDI. We noted no effect of tetracyclines on CDI risk (OR=0.92, 95% CI: 0.61?1.40). In the community setting, there is substantial variation in risk of CDI associated with different antimicrobial classes. Avoidance of high risk antibiotics (such as clindamycin, CMCs and fluoroquinolones) in favor of lower risk antibiotics (such as penicillins, macrolides and tetracyclines) may help reduce the incidence of CDI.


Address for Correspondence Kevin A. Brown, Dalla Lana School of Public Health 155 College Street, Toronto, Ontario, Canada, M5T 3M7, Tel: 416-732-4331, Fax: 416-978-1883, Email: kevin.brown@mail.utoronto.ca

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