Days of antibiotic spectrum coverage (DASC) as predictors of recurrent Clostridioides difficile infection: A retrospective cohort study

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-02-04 DOI:10.1016/j.jiac.2025.102650

Nobuaki Mori , Yuichi Shibata , Jun Hirai , Nobuhiro Asai , Hiroshige Mikamo

{"title":"Days of antibiotic spectrum coverage (DASC) as predictors of recurrent Clostridioides difficile infection: A retrospective cohort study","authors":"Nobuaki Mori , Yuichi Shibata , Jun Hirai , Nobuhiro Asai , Hiroshige Mikamo","doi":"10.1016/j.jiac.2025.102650","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Broad-spectrum antibiotic use increases the risk of <em>Clostridioides difficile</em> infection (CDI), with recurrence rates varying by antibiotic type, spectrum, and treatment duration. We assessed CDI recurrence risk using the days of antibiotic spectrum coverage (DASC) score, considering antibiotic spectrum and use duration.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with hospital-acquired CDI. A logistic regression analysis was used to evaluate CDI recurrence, incorporating three variables: DASC score prior to CDI diagnosis, type of anti-CDI drugs, or DASC score after CDI diagnosis.</div></div><div><h3>Results</h3><div>Overall, 246 patients were included, with 31 (12.6 %) cases of recurrence. Median DASC scores within 30 days prior to CDI diagnosis were higher in the recurrent group than in the non-recurrent group (128 [interquartile range: 106–217] vs. 80 [interquartile range: 39–142], p < 0.01). Using the lowest quartile of DASC scores as the reference, the analysis indicated higher relative risks of CDI recurrence in the upper quartiles. However, daily DASC scores post-CDI diagnosis did not correlate with recurrence. Compared to metronidazole, fidaxomicin lowered the risk of CDI recurrence (relative risk 0.2, 95 % confidence interval: 0.1–0.8, p = 0.03).</div></div><div><h3>Conclusions</h3><div>The DASC score within 30 days prior to CDI diagnosis appears to be a predictive risk factor for CDI recurrence.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 4","pages":"Article 102650"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X25000479","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Broad-spectrum antibiotic use increases the risk of Clostridioides difficile infection (CDI), with recurrence rates varying by antibiotic type, spectrum, and treatment duration. We assessed CDI recurrence risk using the days of antibiotic spectrum coverage (DASC) score, considering antibiotic spectrum and use duration.

Methods

We retrospectively analyzed patients with hospital-acquired CDI. A logistic regression analysis was used to evaluate CDI recurrence, incorporating three variables: DASC score prior to CDI diagnosis, type of anti-CDI drugs, or DASC score after CDI diagnosis.

Results

Overall, 246 patients were included, with 31 (12.6 %) cases of recurrence. Median DASC scores within 30 days prior to CDI diagnosis were higher in the recurrent group than in the non-recurrent group (128 [interquartile range: 106–217] vs. 80 [interquartile range: 39–142], p < 0.01). Using the lowest quartile of DASC scores as the reference, the analysis indicated higher relative risks of CDI recurrence in the upper quartiles. However, daily DASC scores post-CDI diagnosis did not correlate with recurrence. Compared to metronidazole, fidaxomicin lowered the risk of CDI recurrence (relative risk 0.2, 95 % confidence interval: 0.1–0.8, p = 0.03).

Conclusions

The DASC score within 30 days prior to CDI diagnosis appears to be a predictive risk factor for CDI recurrence.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.