Clostridioides difficile infection after pneumonia in elderly patients: which antibiotic is at lower risk?. Issue 3 (July 2020)

• Record Type: Journal Article
• Authors: Bonnassot, P.; Barben, J.; Tetu, J.; Bador, J.; Bonniaud, P.; Manckoundia, P.; Putot, A.
• Is Part Of: Journal of hospital infection. Volume 105:Issue 3(2020)
• Page Start: 527
• Page End: 533
• Publication Date: 2020-07
• Subjects: Clostridioides difficile -- Pneumonia -- β-Lactamase inhibitors -- Elderly -- Antibiotics; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2020.05.009
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Clostridioides difficile infection (CDI) is a frequent and severe complication of antibiotic treatment in elderly patients hospitalized for acute pneumonia (AP). Aim: To assess the burden and risk factors of CDI and to determine which of the usual antibiotics regimens is at lower risk for post-AP CDI incidence. Methods: Among patients aged >75 years hospitalized for AP in all departments of a university hospital between 2007 and 2017, all the 92 patients developing CDI were compared with 213 patients without CDI. Factors associated with (i) in-hospital and one-year mortality and (ii) CDI incidence were assessed using logistic regression models. Findings: In patients with and without CDI after AP, mortality rates were respectively at 34% vs 20% in hospital and 63% vs 42% at one year. After adjustment for confounders, CDI was associated with a two-fold risk of in-hospital and one-year mortality after pneumonia (respectively, odds ratio (OR): 1.95; 95% confidence interval (CI): 1.06–3.58; and OR: 2.02; 95% CI: 1.43–7.31). High number of antibiotics (per antibiotic, OR: 1.89; 95% CI: 1.18–3.06) rather than antibiotics duration (per day, OR: 1.04; 95% CI: 0.96–1.11) was associated with a higher risk of CDI. Compared with other antibiotics, use of penicillin + β-lactamase inhibitors was associated with a lower risk of CDI (OR: 0.43; 95% CI: 0.19–0.99). Conclusion: In elderly inpatients, CDI greatly increases the burden of AP in the short and long term. If confirmed, these results suggest the preferential use of penicillin + β-lactamase inhibitors for a lower incidence of CDI in elderly inpatients with AP.