Common Antibiotics in the Hospital Linked to Greater C Difficile Risk

Credit: Unsplash / Nastya Dulhiier

Several antibiotics commonly given to patients in the intensive care unit (ICU) may be linked to a higher risk of Clostridioides difficile infection (CDI) and adverse drug reactions, according to findings from a retrospective study.

Of more than 100,000 suspected adverse drug reaction reports registered in the database EudraVigilance, most related to CDI were associated with ciprofloxacin, ceftriaxone, and piperacillin/tazobactam. Investigators said the relationship between ICU antibiotic use and CDI risk is "heterogeneous."

“The most used antibiotics in the ICU are non-selective in their action, disrupting gut microbiota and creating an environment in which C. difficile thrives,” the investigators of the study wrote.

The US Centers for Disease Control and Prevention estimates C. difficile causes almost half a million infections in the US each year, noting patients are seven to 10 times more likely to develop CDI when taking antibiotics or during the month thereafter.

Understanding which antibiotics are associated with a greater risk of CDI is essential for developing safe and effective treatment regimens not likely to cause adverse drug reactions.

To assess the risk of CDI associated with the use of commonly administered antibiotics, investigators reviewed CDI Individual Case Safety Reports submitted to EudraVigilance spontaneously reported as adverse drug reactions associated with the use of antibiotics including ceftriaxone, colistimethate, ciprofloxacin, gentamicin, linezolid, meropenem and piperacillin/tazobactam.

Total adverse drug reactions and total cases of CDI for these seven drugs were centralized and used to calculate the proportion of adverse drug reactions related to CDI from total adverse drug reactions reported.

Between January 2003, and August 2023, a total of 119,123 adverse drug reactions were reported in EudraVigilance for the seven antibiotics. The greatest proportions of adverse drug reactions related to CDI were observed for ciprofloxacin (31%), ceftriaxone (29%), piperacillin/tazobactam (14%) and linezolid (12%). Although the number of reports for CDI was greatest for ciprofloxacin, both meropenem and piperacillin/tazobactam had the greatest proportion of adverse drug reactions related to CDI from the total Individual Case Safety Reports (3%).

A retrospective analysis of Individual Case Safety Reports in EudraVigilance between 2003 and 2022 showed the greatest average reports per year for ciprofloxacin and piperacillin/tazobactam, and the lowest for linezolid and colistimethate. For meropenem and gentamicin, the average number of reports per year was 13.6 and 4.9, respectively.

Further analysis of reports with unfavorable outcomes showed the greatest frequency of an unfavorable outcome was observed for ciprofloxacin (21.8%) and meropenem (20.5%) while the lowest frequency of an unfavorable outcome was calculated for gentamicin (11.8%) and ceftriaxone (13.2%).

The greatest frequency of fatal adverse drug reactions was seen in colistimethate (15%), meropenem (14%), and ciprofloxacin (13.6%).

Investigators evaluated the probability of reporting CDI related to the seven antibiotics included in the study compared to amikacin, ceftazidime, clindamycin, imipenem/cilastatin, and levofloxacin. Results showed all studied antibiotics had a lower reporting probability when compared to clindamycin.

“There is a pressing need to promote responsible antibiotic usage to prevent adverse events and preserve the efficacy of these valuable medications," investigators concluded. "An increasing rate of severe forms of CDI imposes the necessity to carry out surveillance and monitoring programs for the consumption of antibiotics."

An original version of this article was published on sister site HCPLive.