High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections.

Abstract

AIM:

To characterize the use of common urinary tract infections (UTI)-relevant antibiotics after an SCI and determine the risk of Clostridium difficile infection (CDI) from these antibiotics.

METHODS:

We used routinely collected data from Ontario (Canada) to conduct a retrospective, cohort study. We identified people >18 years of age with a traumatic SCI between April 2003 and March 2017. The primary exposure was an outpatient UTI-relevant antibiotic prescription during our observation period, and the primary outcome was evidence of a CDI. An adjusted cox proportional hazards model was used, and antibiotic exposure was modeled as a categorical, time-varying variable based on whether the patient likely had a UTI or not.

RESULTS:

We identified 2528 people with SCI; 1642 (65%) were exposed at least once to an antibiotic of interest. The most commonly prescribed UTI-relevant antibiotic was fluoroquinolone (34%). Most patients did not have investigations for a UTI before the use of any of the different antibiotic classes. A small number of patients (5%) used chronic (>3 months) UTI-relevant antibiotics. The overall proportion of patients diagnosed with CDI was 7.4% (9.3/10 000 patient-days). The adjusted hazard ratio for CDI within 30 days was 3.5 (95% confidence interval, 1.9-6.7, p < .01) if they were exposed to a UTI-relevant antibiotic likely associated with a UTI, which was similar to the risk from UTI-relevant antibiotics which may not have been for a UTI.

CONCLUSIONS:

The rate of CDI is high in this population and outpatient antibiotics that are commonly used for UTIs are a significant risk factor for CDI.

• Authors: Bonnie Liu, Jennifer Reid, Michael Silverman, Blayne Welk
• Journal: Neurourology and urodynamics (Neurourol Urodyn) Vol. 39 Issue 8 Pg. 2401-2408 (11 2020) ISSN: 1520-6777 [Electronic] United States
• PMID: 32902908 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 Wiley Periodicals LLC.

Chemical References

• Anti-Bacterial Agents
• Fluoroquinolones

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Canada
• Clostridium Infections (epidemiology, etiology)
• Cohort Studies
• Female
• Fluoroquinolones (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk
• Spinal Cord Injuries (complications)
• Urinary Tract Infections (drug therapy, etiology)