Common Antibiotics Associated with C. difficile Infection Include Piperacillin, Meropenem

The antibiotics most commonly associated with clostridium difficile infection (CDI) are piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin, a new study published in the National Library of Medicine shows.

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The retrospective study, conducted at a cancer care center in Pakistan over an 8-year period, aimed to evaluate these common antibiotics and their relation to CDI development in recent years, especially in Asia, where there is a lack of research on the topic, the researchers wrote.

“Our study supports the results of previous studies that prior admission for more than 3 days, use of antibiotics, including piperacillin-tazobactam, carbapenems, ciprofloxacin, penicillins, and proton pump inhibitors is associated with CDI,” the investigators determined.

The study included 58 patients, of whom 79.3% (46) were male and 20.7% (12) were female. The mean age of the participants was 30 years (standard deviation +56), with 62% (36) of patients being adults and 38% (22) being children.

Antibiotics that were administered for a duration of at least 4 days were given to 93% (54) of patients who developed CDI, the results show. The most common antibiotics prescribed were piperacillin/tazobactam given in 77.60% (45/58) of patients, followed by meropenem given in 27.60% (16/58), vancomycin in 20.70% (12/58), ciprofloxacin given in 17.20% (10/58), ceftriaxone given in 16% (9/58), and levofloxacin given in 14% (8/58) respectively, the results of the study show.

Aside from administered antibiotics, 98% (57) of patients given standard doses of proton pump inhibitors, 93% (54) of patients who had a hospital stay of more than 3 days in the past 3 months, 24% (15) of patients who had neutropenia, 20.1% (12) of patients who were over 65 years of age, 14% (8) of patients who had diabetes mellitus, and 12% (7) of patients who had chronic kidney disease developed CDI, the investigators observed.

Most of the CDI that developed in patients occurred in those with solid organ tumors and neutropenia—14%, or 14 of 58 patients, according to the study. Other than antibiotic exposure, the administration of protein pump inhibitors and prior hospital visits were the most common risk factors for developing CDI.

Males were affected more than females and adults were affected more than children, the results of the study show.

“As our study population consisted of complicated cancer patients on treatment as well as other complications, the risk of CDI was increased not only because of antibiotics use but also because of malignancy, age, comorbidities, and surgery, thus confounding the culprit antibiotics,” the researchers said.

The investigators acknowledged strengths and limitations of their study. The primary strength was the study’s long duration and the resulting recognition on a complex problem that has been neglected in complicated patients in Pakistan. The primary weakness of the study was its retrospective, single-center design and the small sample size of the participants, the researchers wrote.

“Few patients with CDI did not receive any prior antibiotics but had other risk factors of proton pump inhibitor use, prior hospital admission, solid organ malignancy, neutropenia, DM, and CKD. If patients with these risk factors develop diarrhea, they should be evaluated for CDI,” the investigators concluded.

Reference

Rafey, A., et. al. (2023) Antibiotics associated with clostridium difficile infection. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10266117/. Accessed on June 20, 2023.