Risk of Clostridium difficile Infection in Hospitalized Patients Receiving Metronidazole for a Non-C difficile Infection.
Clin Gastroenterol Hepatol. 2014 Mar 26;
Authors: Rodriguez S, Hernandez MB, Tarchini G, Zaleski M, Vantanchi M, Cardona L, Castro-Pavia F, Schneider A
BACKGROUND: & Aims: Antibiotics are often given to prevent infections but also constitute a risk factor for Clostridium difficile infection (CDI). Metronidazole is an effective treatment for CDI. We investigated whether prophylactic administration of metronidazole to patients before they receive other antibiotics reduces the risk of CDI.
METHODS: We performed a retrospective cohort analysis of data collected from 12,026 high-risk patients admitted to Cleveland Clinic Foundation Hospitals from 2008 through 2012. High-risk patients were defined as 55 y old or older who received a broad-spectrum antibiotic (piperacillin-tazobactam or ciprofloxacin) and a gastric acid suppressant (a proton pump inhibitor or a histamine-2 blocker). Development of CDI was compared between patients who received metronidazole for non-CDI indications before broad-spectrum antibiotics (n=811) and those who did not (n=11,215). Logistic regression was used to control for patient demographics and co-morbidities.
RESULTS: The rate of CDI was 1.4% (n=11) among the patients who received metronidazole for non-CDI indications and 6.5% (n=728) among those who did not. We observed an 80% reduction in CDI among patients who received metronidazole (odds ratio, 0.21; 95% confidence interval, 0.11-0.38; P<.001), adjusted for age, sex, and comorbidities.
DISCUSSION: Based on a retrospective analysis, metronidazole might be used to prevent CDI in certain high-risk patients. Prospective controlled trials are necessary prior to making further recommendations.
PMID: 24681079 [PubMed - as supplied by publisher]