Perhaps one of the most challenging and neglected issues in healthcare infection prevention and control is Clostridioides difficile (C diff). This bacterial infection poses a problem for multiple reasons: it is exceedingly difficult to remove through cleaning/disinfection: requires handwashing with soap and water (versus alcohol-base hand sanitizer); requires specific isolation precautions; is difficult to treat, and can be devastating to patients and families. The CDC notes that C diff is a major public health threat. There were over 223,900 cases in hospitalized patients in 2017, and of them, 12,800 died. C diff is most likely to occur in those 65 years and older taking antibiotics and receiving medical care, staying in hospitals or nursing homes for long periods of time, and with weakened immune systems and previous C diff infection.
As we increasingly work to combat this bacterial infection, understanding which antibiotics pose the largest risk becomes the biggest challenge. A recent study published in Cureus assessed antibiotics associated with C diff infection. Noting that type BI/NAP1/027 is the C diff strain responsible for the most severe infection, the authors called attention to the fact that C diff is the major cause of antibiotic-induced diarrhea followed by pathogens like Staphylococcus aureus and Clostridium perfringens.
Antimicrobials such as clindamycin, cephalosporins, penicillins, and fluoroquinolones have been linked with causing C diff infection, which the authors worked to assess through a retrospective, single-center study across 8 years. Evaluating 58 patients within the study, they looked at a range of variables including age, antibiotics given, previous hospital stays for more than 3 days within the last 3 months, comorbidities, and other factors.
3 Key Takeaways
- Specific antibiotics, such as piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin, were found to be associated with C diff infection
- Prior hospital admission for more than 3 days within the last 3 months and the use of specific antibiotics were associated with greater risk
- Chronic conditions, the use of proton pump inhibitors, and neutropenia were also noted as potential variables contributing to risk of C diff infection
The authors discovered several interesting findings. First, a majority were male (79.3%), 62% were adults, and the mean age was 30 years (SD +56). Solid organ malignancy was present in 67.2% of patients and 38% were noted to have severe C diff infection. They also reported that 93% of participants had received at least 4 days of antibiotic treatment in the last 3 months. The most common antibiotics given were piperacillin/tazobactam (77.6%; 45/58); meropenem (27.60%; 16/58); vancomycin (20.70%; 12/58); ciprofloxacin (17.20%; 10/58); ceftriaxone (16%; 9/58); and levofloxacin (14%; 8/58). Ninety-eight percent of patients were treated with proton pump inhibitors with standard dosing and 93% had a previous hospital stay for more than 3 days within the last 3 months. Nearly a quarter of patients were neutropenic.
Ultimately, the authors stressed that prior admission for more than 3 days and use of specific antibiotics were associated with C diff infection. “The results of our study showed that the most common antibiotics associated with C difficile infection were piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin. Seven percent (7%; 4/58) of patients with CDI did not receive any prior antibiotics.”
While this was a smaller study and future research should expand the sample size, especially within long-term care facilities, certain chronic conditions and the use of proton pump inhibitors presents interesting variables to consider. Nonetheless, awareness for these factors should be incorporated with stronger infection prevention efforts.
Rafey A, Jahan S, Farooq U, et al. Antibiotics associated with clostridium difficile infection. Cureus. Published online May 15, 2023. doi:10.7759/cureus.39029