This article is more than 5 years old. Information may no longer be current.
Prophylactic Invanz use linked with increased risk for C. difficile
Click Here to Manage Email Alerts
Prophylactic Invanz use significantly increased the risk for developing Clostridium difficile in surgical patients, according to recent study results.
“Our study suggests that [Invanz] use as surgical prophylaxis was associated with an increased risk for [C. difficile infection] in our patient population,” Seungwon Lee, MPH, of the department of hospital epidemiology and infection control at the University of California San Francisco Medical Center, and colleagues wrote.
“Alternative agents should be considered as part of an antimicrobial stewardship strategy aiming to reduce [C. difficile infection] risk among surgical patients, particularly among those undergoing noncolorectal surgery.”
Lee and colleagues identified 46 patients with C. difficile from two surgical units and matched them to 92 control patients. They found that, while the C. difficile and control groups were matched for age, comorbidities and other demographic information, the rate of cystectomy (13% vs. 4%) and Whipple procedures (11% vs. 3%) were greater in the C. difficile group vs. controls. The researchers also noted a longer mean operating time in C. difficile cases compared with control cases (370 minutes vs. 295 minutes). There was no significant difference in risk for C. difficile infection between either group regarding gastrointestinal surgery and nongastrointestinal surgery, gastric acid suppression, bowel preparation and enteral nutrition.
While use of prophylactic cefazolin was associated with a decreased risk for C. difficile infection, Invanz (ertapenem, Merck Sharpe & Dohme) prophylaxis increased the risk (adjusted OR = 3.13; 95% CI, 1.13–8.68). Ertapenem was used as prophylaxis in the study for many surgical procedures beyond colorectal surgery, including cystectomy, Whipple procedure, adrenalectomy, gastrectomy, hernia repair and hepatectomy. Lee and colleagues noted that 10 patients who underwent nongastrointestinal surgery and used ertapenem developed C. difficile infection.
“The increased risk of [C. difficile infection] observed with ertapenem may potentially be due to its enhanced anaerobic activity, which may have a more disruptive effect on the fecal microbiota, as described with other antibiotics with anaerobic activity, such as gatifloxacin and moxifloxacin,” Lee and colleagues wrote. – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts