Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis

Slimings, Claudia; Riley, Thomas V.

doi:10.1093/jac/dkt477

Cited by 489 publications

(396 citation statements)

References 32 publications

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“…30 Current data suggest that clindamycin, oral cephalosporins, and fluoroquinolone-class antibiotics are associated with an increased risk of both community-acquired and hospital-acquired C difficileassociated disease. 31,32 Cardiotoxicity of fluoroquinolones is well described in adults and relates to the propensity of such drugs to prolong the QT interval through blockage of the voltagegated potassium channels, especially the rapid component of the delayed rectifier potassium current I(Kr), expressed by HERG (the human ether-a-go-go-related gene). Moxifloxacin has the greatest risk to prolong the QT interval and should be avoided in patients with long QT syndrome, those with hypokalemia or hypomagnesemia, those with organic heart disease including congestive heart failure, those receiving an antiarrhythmic agent from class Ia or class III (eg, quinidine and procainamide or amiodarone and sotaolo, respectively), those who are receiving a concurrent drug that prolongs the QTc interval independently, and those with hepatic insufficiency-related metabolic derangements that may promote QT prolongation.…”

Section: Additional Risks/considerationsmentioning

confidence: 99%

The Use of Systemic and Topical Fluoroquinolones

Jackson¹,

Schutze²

2016

Pediatrics

137

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Appropriate prescribing practices for fluoroquinolones, as well as all antimicrobial agents, are essential as evolving resistance patterns are considered, additional treatment indications are identified, and the toxicity profile of fluoroquinolones in children has become better defined. Earlier recommendations for systemic therapy remain; expanded uses of fluoroquinolones for the treatment of certain infections are outlined in this report. Prescribing clinicians should be aware of specific adverse reactions associated with fluoroquinolones, and their use in children should continue to be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone treatment represents a reasonable alternative to parenteral antimicrobial therapy.

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Section: Additional Risks/considerationsmentioning

confidence: 99%

The Use of Systemic and Topical Fluoroquinolones

Jackson¹,

Schutze²

2016

Pediatrics

137

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“…There are several risk factors with high association with CDI, including recent antibiotic exposure, age (> 65 years), recent hospitalization, and proton pump inhibitor use [35] . Antibiotic exposure shows the highest correlation, with odds ratios ranging from 1.311.87 [39] . Certain antibiotics also demonstrate higher correlations, such as clindamycin [39] ; indeed, this finding correlates with the history of the disease since CDI was originally referred to as clindamycinassociated pseudomembranous colitis [33] .…”

Section: Epidemiology and Risk Factors For CDImentioning

confidence: 99%

Gastrointestinal dysbiosis and the use of fecal microbial transplantation inClostridium difficileinfection

Schenck

Beck

MacDonald

2015

WJGP

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The impact of antibiotics on the human gut microbiota is a significant concern. Antibiotic-associated diarrhea has been on the rise for the past few decades with the increasing usage of antibiotics. Clostridium difficile infections (CDI) have become one of the most prominent types of infectious diarrheal disease, with dramatically increased incidence in both the hospital and community setting worldwide. Studies show that variability in the innate host response may in part impact upon CDI severity in patients. That being said, CDI is a disease that shows the most prominent links to alterations to the gut microbiota, in both cause and treatment. With recurrence rates still relatively high, it is important to explore alternative therapies to CDI. Fecal microbiota transplantation (FMT) and other types of bacteriotherapy have become exciting avenues of treatment for CDI. Recent clinical trials have generated excitement for the use of FMT as a therapeutic option for CDI; however, the exact components of the human gut microbiota needed for protection against CDI have remained elusive. Additional investigations on the effects of antibiotics on the human gut microbiota and subsequent CDI will help reduce the socioeconomic burden of CDI and potentially lead to new therapeutic modalities.

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“…Several reviews and guidelines for controlling CDI have been published 154,155,157,[191][192][193][194][195] . Although some differences exist, most of these guidelines have similar recommendations (BOX 3).…”

Section: Management Infection Controlmentioning

confidence: 99%