Cumulative Antibiotic Exposures Over Time and the Risk of Clostridium difficile Infection

摘要: Background Clostridium difficile infection (CDI) is a major cause of hospital-acquired diarrhea and most commonly associated with changes in normal intestinal flora caused by administration antibiotics. Few studies have examined the risk CDI total dose, duration, or number antibiotics while taking into account complex exposures over time. Methods A retrospective cohort study conducted from 1 January to 31 December 2005 among hospitalized patients 18 years older receiving 2 more days Results The identified 10,154 hospitalizations for 7,792 unique 241 cases CDI, defined as detection C. toxin diarrheal stool sample within 60 discharge. We observed dose-dependent increases increasing cumulative antibiotics, antibiotic exposure. Compared who received only antibiotic, adjusted hazard ratios (HRs) those 2, 3 4, 5 were 2.5 (95% confidence interval [CI] 1.6-4.0), 3.3 (CI 2.2-5.2), 9.6 6.1-15.1), respectively. receipt fluoroquinolones was an increased metronidazole reduced risk. Conclusions Cumulative appear be CDI. Antimicrobial stewardship programs that focus on overall reduction dose well exposure substitution high-risk classes lower-risk alternatives may reduce incidence