Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis
Abstract Background: Clostridioides difficile infection (CDI) is a common and often nosocomial infection associated with increased mortality and morbidity. Antibiotic use is the most important modifiable risk factor, but many patients require empiric antibiotics. We estimated the increased risk o...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25000105/type/journal_article |
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| author | Matthew A. Pappas Shoshana J. Herzig Andrew D. Auerbach Abhishek Deshpande Eunice Blanchard Michael B. Rothberg |
| author_facet | Matthew A. Pappas Shoshana J. Herzig Andrew D. Auerbach Abhishek Deshpande Eunice Blanchard Michael B. Rothberg |
| author_sort | Matthew A. Pappas |
| collection | DOAJ |
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Abstract
Background:
Clostridioides difficile infection (CDI) is a common and often nosocomial infection associated with increased mortality and morbidity. Antibiotic use is the most important modifiable risk factor, but many patients require empiric antibiotics. We estimated the increased risk of hospital-onset CDI with one daily dose-equivalent (DDE) of various empiric antibiotics compared to management without that daily dose-equivalent.
Methods:
Using a multicenter retrospective cohort of adults admitted between March 2, 2020 and February 11, 2021 for the treatment of SARS-CoV-2, we used a series of three-level logistic regression models to estimate the probability of receiving each of several antibiotics of interest. For each antibiotic, we then limited our data set to patient-days at intermediate probability of receipt and used augmented inverse-probability weighted models to estimate the average treatment effect of one daily dose-equivalent, compared to management without that daily dose-equivalent, on the probability of hospital-onset CDI.
Results:
In 24,406 patient-days at intermediate probability of receipt, parenteral vancomycin increased risk of hospital-onset CDI, with an average treatment effect of 0.0096 cases per daily dose-equivalent (95% CI: 0.0053—0.0138). In 38,003 patient-days at intermediate probability of receipt, cefepime also increased subsequent CDI risk, with an estimated effect of 0.0074 more cases per daily dose-equivalent (95% CI: 0.0022—0.0126).
Conclusions:
Among common empiric antibiotics, parenteral vancomycin and cefepime appeared to increase risk of hospital-onset CDI. Causal inference observational study designs can be used to estimate patient-level harms of interventions such as empiric antimicrobials.
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| format | Article |
| id | doaj-art-e4ebc0534c2b43869d513cdbe0860190 |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-e4ebc0534c2b43869d513cdbe08601902025-02-12T07:09:19ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.10Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysisMatthew A. Pappas0https://orcid.org/0000-0002-0353-1785Shoshana J. Herzig1https://orcid.org/0000-0001-8005-4727Andrew D. Auerbach2Abhishek Deshpande3https://orcid.org/0000-0001-5522-2995Eunice Blanchard4https://orcid.org/0000-0002-2939-2445Michael B. Rothberg5Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA COVID-19 Consortium of HCA Healthcare and Academia for Research Generation, Nashville, TN, USACOVID-19 Consortium of HCA Healthcare and Academia for Research Generation, Nashville, TN, USA Department of Medicine, Division of General Medicine, and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USACOVID-19 Consortium of HCA Healthcare and Academia for Research Generation, Nashville, TN, USA Department of Hospital Medicine, University of California, San Francisco, CA, USACenter for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USACOVID-19 Consortium of HCA Healthcare and Academia for Research Generation, Nashville, TN, USA Infection Control and Hospital Epidemiology, HCA Healthcare, Nashville, TN, USACenter for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA Abstract Background: Clostridioides difficile infection (CDI) is a common and often nosocomial infection associated with increased mortality and morbidity. Antibiotic use is the most important modifiable risk factor, but many patients require empiric antibiotics. We estimated the increased risk of hospital-onset CDI with one daily dose-equivalent (DDE) of various empiric antibiotics compared to management without that daily dose-equivalent. Methods: Using a multicenter retrospective cohort of adults admitted between March 2, 2020 and February 11, 2021 for the treatment of SARS-CoV-2, we used a series of three-level logistic regression models to estimate the probability of receiving each of several antibiotics of interest. For each antibiotic, we then limited our data set to patient-days at intermediate probability of receipt and used augmented inverse-probability weighted models to estimate the average treatment effect of one daily dose-equivalent, compared to management without that daily dose-equivalent, on the probability of hospital-onset CDI. Results: In 24,406 patient-days at intermediate probability of receipt, parenteral vancomycin increased risk of hospital-onset CDI, with an average treatment effect of 0.0096 cases per daily dose-equivalent (95% CI: 0.0053—0.0138). In 38,003 patient-days at intermediate probability of receipt, cefepime also increased subsequent CDI risk, with an estimated effect of 0.0074 more cases per daily dose-equivalent (95% CI: 0.0022—0.0126). Conclusions: Among common empiric antibiotics, parenteral vancomycin and cefepime appeared to increase risk of hospital-onset CDI. Causal inference observational study designs can be used to estimate patient-level harms of interventions such as empiric antimicrobials. https://www.cambridge.org/core/product/identifier/S2732494X25000105/type/journal_article |
| spellingShingle | Matthew A. Pappas Shoshana J. Herzig Andrew D. Auerbach Abhishek Deshpande Eunice Blanchard Michael B. Rothberg Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis |
| title_full | Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis |
| title_fullStr | Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis |
| title_full_unstemmed | Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis |
| title_short | Impact of empiric antibiotics on risk of Clostridioides difficile—a causal inference observational analysis |
| title_sort | impact of empiric antibiotics on risk of clostridioides difficile a causal inference observational analysis |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25000105/type/journal_article |
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