High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections
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 i...
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| Veröffentlicht in: | Neurourology and urodynamics 2020-11, Vol.39 (8), p.2401-2408 |
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| creator | Liu, Bonnie Reid, Jennifer Silverman, Michael Welk, Blayne |
| description | 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 |
| doi_str_mv | 10.1002/nau.24502 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2451544922</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2451544922</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2682-aed25fa1a615ade41b95c89da3b035478a1d588f602830166c16294d32bdf3673</originalsourceid><addsrcrecordid>eNp1kU1LwzAYx4Mobk4PfgEJePLQLS9t2h7HUCcMvbhzSfOyZbbNTFJk38UPa-amnoRACM8vvyf5PwBcYzTGCJFJx_sxSTNETsAQZwQlLM_zUzBEOaUJSVk-ABfebxBCBU3LczCgpERxFUPwOTerNXTGv0Gr4ayxPjgjTd9CabQ2wjQKmk4rEYztIG9tt4J-azreQGGdjLVN75SEWx6M6oKHXAflYFgr2Hu1d_IumNrYYISPV9poaHb7moTBwuAUD7B3Ueh28cRF-GvnL8GZ5o1XV8d9BJYP96-zebJ4eXyaTReJIKwgCVeSZJpjznDGpUpxXWaiKCWnNaJZmhccy6woNEOkoAgzJjAjZSopqaWmLKcjcHvwbp1975UP1cb2Lv7RVzFWnKVpSUik7g6UcNZ7p3S1daaN764wqvZzqOIcqu85RPbmaOzrVslf8if4CEwOwEdMePe_qXqeLg_KLzwTlJo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2451544922</pqid></control><display><type>article</type><title>High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Liu, Bonnie ; Reid, Jennifer ; Silverman, Michael ; Welk, Blayne</creator><creatorcontrib>Liu, Bonnie ; Reid, Jennifer ; Silverman, Michael ; Welk, Blayne</creatorcontrib><description>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.</description><identifier>ISSN: 0733-2467</identifier><identifier>EISSN: 1520-6777</identifier><identifier>DOI: 10.1002/nau.24502</identifier><identifier>PMID: 32902908</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - therapeutic use ; antibiotic ; Antibiotics ; Canada ; Clostridium difficile ; Clostridium Infections - epidemiology ; Clostridium Infections - etiology ; Cohort Studies ; Female ; Fluoroquinolones - adverse effects ; Fluoroquinolones - therapeutic use ; Humans ; Male ; Middle Aged ; Patients ; Retrospective Studies ; Risk ; Risk factors ; Spinal cord injuries ; Spinal Cord Injuries - complications ; spinal cord injury ; Urinary tract ; Urinary tract diseases ; urinary tract infection ; Urinary tract infections ; Urinary Tract Infections - drug therapy ; Urinary Tract Infections - etiology ; Urogenital system</subject><ispartof>Neurourology and urodynamics, 2020-11, Vol.39 (8), p.2401-2408</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2682-aed25fa1a615ade41b95c89da3b035478a1d588f602830166c16294d32bdf3673</citedby><cites>FETCH-LOGICAL-c2682-aed25fa1a615ade41b95c89da3b035478a1d588f602830166c16294d32bdf3673</cites><orcidid>0000-0001-7093-558X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fnau.24502$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fnau.24502$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32902908$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Bonnie</creatorcontrib><creatorcontrib>Reid, Jennifer</creatorcontrib><creatorcontrib>Silverman, Michael</creatorcontrib><creatorcontrib>Welk, Blayne</creatorcontrib><title>High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections</title><title>Neurourology and urodynamics</title><addtitle>Neurourol Urodyn</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>antibiotic</subject><subject>Antibiotics</subject><subject>Canada</subject><subject>Clostridium difficile</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - etiology</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fluoroquinolones - adverse effects</subject><subject>Fluoroquinolones - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk factors</subject><subject>Spinal cord injuries</subject><subject>Spinal Cord Injuries - complications</subject><subject>spinal cord injury</subject><subject>Urinary tract</subject><subject>Urinary tract diseases</subject><subject>urinary tract infection</subject><subject>Urinary tract infections</subject><subject>Urinary Tract Infections - drug therapy</subject><subject>Urinary Tract Infections - etiology</subject><subject>Urogenital system</subject><issn>0733-2467</issn><issn>1520-6777</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1LwzAYx4Mobk4PfgEJePLQLS9t2h7HUCcMvbhzSfOyZbbNTFJk38UPa-amnoRACM8vvyf5PwBcYzTGCJFJx_sxSTNETsAQZwQlLM_zUzBEOaUJSVk-ABfebxBCBU3LczCgpERxFUPwOTerNXTGv0Gr4ayxPjgjTd9CabQ2wjQKmk4rEYztIG9tt4J-azreQGGdjLVN75SEWx6M6oKHXAflYFgr2Hu1d_IumNrYYISPV9poaHb7moTBwuAUD7B3Ueh28cRF-GvnL8GZ5o1XV8d9BJYP96-zebJ4eXyaTReJIKwgCVeSZJpjznDGpUpxXWaiKCWnNaJZmhccy6woNEOkoAgzJjAjZSopqaWmLKcjcHvwbp1975UP1cb2Lv7RVzFWnKVpSUik7g6UcNZ7p3S1daaN764wqvZzqOIcqu85RPbmaOzrVslf8if4CEwOwEdMePe_qXqeLg_KLzwTlJo</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Liu, Bonnie</creator><creator>Reid, Jennifer</creator><creator>Silverman, Michael</creator><creator>Welk, Blayne</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0001-7093-558X</orcidid></search><sort><creationdate>202011</creationdate><title>High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections</title><author>Liu, Bonnie ; Reid, Jennifer ; Silverman, Michael ; Welk, Blayne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2682-aed25fa1a615ade41b95c89da3b035478a1d588f602830166c16294d32bdf3673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>antibiotic</topic><topic>Antibiotics</topic><topic>Canada</topic><topic>Clostridium difficile</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - etiology</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fluoroquinolones - adverse effects</topic><topic>Fluoroquinolones - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk factors</topic><topic>Spinal cord injuries</topic><topic>Spinal Cord Injuries - complications</topic><topic>spinal cord injury</topic><topic>Urinary tract</topic><topic>Urinary tract diseases</topic><topic>urinary tract infection</topic><topic>Urinary tract infections</topic><topic>Urinary Tract Infections - drug therapy</topic><topic>Urinary Tract Infections - etiology</topic><topic>Urogenital system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Bonnie</creatorcontrib><creatorcontrib>Reid, Jennifer</creatorcontrib><creatorcontrib>Silverman, Michael</creatorcontrib><creatorcontrib>Welk, Blayne</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Neurourology and urodynamics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Bonnie</au><au>Reid, Jennifer</au><au>Silverman, Michael</au><au>Welk, Blayne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections</atitle><jtitle>Neurourology and urodynamics</jtitle><addtitle>Neurourol Urodyn</addtitle><date>2020-11</date><risdate>2020</risdate><volume>39</volume><issue>8</issue><spage>2401</spage><epage>2408</epage><pages>2401-2408</pages><issn>0733-2467</issn><eissn>1520-6777</eissn><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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32902908</pmid><doi>10.1002/nau.24502</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0001-7093-558X</orcidid></addata></record> |
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| ispartof | Neurourology and urodynamics, 2020-11, Vol.39 (8), p.2401-2408 |
| issn | 0733-2467 1520-6777 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - therapeutic use antibiotic Antibiotics Canada Clostridium difficile Clostridium Infections - epidemiology Clostridium Infections - etiology Cohort Studies Female Fluoroquinolones - adverse effects Fluoroquinolones - therapeutic use Humans Male Middle Aged Patients Retrospective Studies Risk Risk factors Spinal cord injuries Spinal Cord Injuries - complications spinal cord injury Urinary tract Urinary tract diseases urinary tract infection Urinary tract infections Urinary Tract Infections - drug therapy Urinary Tract Infections - etiology Urogenital system |
| title | High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections |
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