| アブストラクト | OBJECTIVE: Antibiotic utilization stands as the strongest modifiable determinant for Clostridioides difficile infection (CDI). However, previous studies have relied on aggregated antibiotic categories, leaving prescribers without detailed comparative risk information for individual antibiotics. The objective of this study was to estimate the risk of CDI comprehensively across specific antibiotics. METHODS: Two methodologies were integrated to access and rank the risk of CDI associated with individual antibiotics or classes. Initially, a network comparison was conducted by analysing data from randomized controlled trials (RCTs). Subsequently, a real-world disproportionality analysis using the Food and Drug Adverse Event Reporting System (FAERS) database complemented and enriched the findings from RCTs. RESULTS: The network comparison, encompassing 61 RCTs with 25,931 patients, revealed that exposure to cefepime [odds ratio (OR) 2.56, 95% confidence interval (CI) 1.20-5.44; P=0.02] and imipenem/cilastatin (OR 3.86, 95% CI 1.61-9.29; P=0.003) exhibited higher frequencies of CDI compared with piperacillin/tazobactam. No significant differences were observed between the carbapenems, albeit a trend indicating higher incidence of CDI with imipenem/cilastatin compared with meropenem (OR 3.89, 95% CI 0.94-16.09). In the FAERS disproportionality analysis, nearly all antibiotics displayed associations with CDI, and CDI risk signals often clustered within the majority of antibiotic classes. Among these, lincomycin demonstrated the strongest association (OR 112.17, 95% CI 51.68-243.43). Additionally, oral third-generation cephalosporins tended to exhibit higher CDI risk signals than other antibiotics. CONCLUSIONS: The findings unveiled substantial diversity in the risk of CDI, both within and between antibiotic classes, providing valuable guidance for clinicians in antibiotic prescription decisions and for initiatives aimed at antibiotic stewardship. |
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| ジャーナル名 | International journal of antimicrobial agents |
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| 投稿日 | 2024/8/2 |
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| 投稿者 | Liu, Yangxi; Dai, Mengfei; Zhang, Kanghuai; Zhang, Li; Lin, Bin; Chen, Keyu; Wang, Haitao; Gu, Zhichun; Yu, Yuetian; Wang, Yan |
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| 組織名 | Department of Pharmacy, Second Affiliated Hospital of Xi'an Jiaotong University,;Xi'an, China; Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong;University School of Medicine, Shanghai, China.;Department of Pharmacy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine,;Chinese Academy of Sciences, Hangzhou, Zhejiang, China.;Xi'an, China.;Department of Pharmacy, Changxing People's Hospital; Changxing Branch, Second;Affiliated Hospital of Zhejiang University School of Medicine, Changxing, China.;Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of;Medicine, Shanghai, China.;Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong;University School of Medicine, Shanghai, China; Key Laboratory of Multiple Organ;Failure, Ministry of Education, Zhejiang, China. Electronic address:;fishyyt@sina.com.;Xi'an, China; Key Laboratory of Surgical Critical Care and Life Support (Xi'an;Jiaotong University), Ministry of Education, Xi'an, China. Electronic address:;wangyan0819@mail.xjtu.edu.cn. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/39089342/ |
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