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Most C. difficile occurred after ceasing antibiotics, antibiotic monitoring
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Continued follow-up after cessation of community-based parenteral anti-infective therapy may prevent the development of post-treatment Clostridium difficile, according to findings presented here.
Researchers from the Cleveland Clinic presented data from 2,254 patients who had received 2,724 courses of antibiotic therapy and who had been discharged.
Community-based parenteral anti-infective therapy-associated C. difficile developed in 21 patients, yielding an incidence of 0.95 cases per 100 antibiotic courses. Those cases developed an average of 27 days (range: four to 62 days) after discharge; 85% of them occurred after antibiotic therapy had ceased. One patient required hospitalization due to C. difficile-associated disease.
There were three cases of C. difficile among 138 courses of ampicillin-sulbactam, yielding an incidence rate of 2.2 cases per 100 courses. Two cases of C. difficile occurred among 114 courses of micafungin, yielding an incidence rate of 1.8 cases per 100 antibiotic therapy courses. Incidence rates for ertapenem, piperacillin-tazobactam, ceftriaxone and vancomycin were between 0.6 and 0.9 cases per 100 courses. Rates for oxacillin, imipenem and daptomycin were between 0.2 and 0.3 cases per 100 courses.
Shrestha N. #345. Presented at SHEA 2009 Annual Scientific Meeting. March 19-March 22, 2009. San Diego.
In terms of the relationship between antibiotics and C. difficile, this does not offer anything too new. The researchers’ well-established point is that you need to consider C. difficile in patients who develop diarrhea after treatment with antibiotics has stopped.
The surprising thing here is that micafungin is included and was associated with C. difficile. I am unsure what the exact mechanism would be for that. There is not enough information on the two patients who were on micafungin and contracted C. difficile to elaborate. People are going to read this and wonder, for example, whether these patients also had antibacterials within three months. However, if micafungin was related to the C. difficile, then this would be very important, because the patients in this study taking micafungin had a higher rate of infection than the patients taking antibiotics. I personally am not aware of any evidence of this relationship, but if it exists, we need to pay attention to it.
– George Pankey, MD
Infectious Disease News Editorial Board member