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Emergence of Fluoroquinolones as the Predominant Risk Factor for Clostridium difficile–Associated Diarrhea: A Cohort Study during an Epidemic in Quebec

Pépin, Jacques ; Saheb, Nathalie ; Coulombe, Marie-Andrée ; Alary, Marie-Eve ; Corriveau, Marie-Pier ; Authier, Simon ; Leblanc, Michel ; Rivard, Geneviève ; Bettez, Mathieu ; Primeau, Valérie ; Nguyen, Martin ; Jacob, Claude-Émilie ; Lanthier, Luc

Clinical infectious diseases, 2005-11, Vol.41 (9), p.1254-1260 [Periódico revisado por pares]

Chicago, IL: The University of Chicago Press

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Título:
Emergence of Fluoroquinolones as the Predominant Risk Factor for Clostridium difficile–Associated Diarrhea: A Cohort Study during an Epidemic in Quebec
Autor: Pépin, Jacques ; Saheb, Nathalie ; Coulombe, Marie-Andrée ; Alary, Marie-Eve ; Corriveau, Marie-Pier ; Authier, Simon ; Leblanc, Michel ; Rivard, Geneviève ; Bettez, Mathieu ; Primeau, Valérie ; Nguyen, Martin ; Jacob, Claude-Émilie ; Lanthier, Luc
Assuntos: Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibacterial agents ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Biological and medical sciences ; Cephalosporins ; Clostridium ; Clostridium difficile ; Cohort Studies ; Diarrhea ; Diarrhea - epidemiology ; Diarrhea - microbiology ; Disease Outbreaks ; Enterocolitis, Pseudomembranous - chemically induced ; Enterocolitis, Pseudomembranous - complications ; Enterocolitis, Pseudomembranous - epidemiology ; Epidemics ; Episodes of care ; Female ; Fluoroquinolones ; Fluoroquinolones - adverse effects ; Hospital admissions ; Humans ; Infectious diseases ; Major Articles ; Male ; Medical sciences ; Middle Aged ; Pharmacology. Drug treatments ; Predisposing factors ; Proton pump inhibitors ; Quebec - epidemiology ; Retrospective Studies ; Risk Factors
É parte de: Clinical infectious diseases, 2005-11, Vol.41 (9), p.1254-1260
Notas: ark:/67375/HXZ-GRF0QTHX-8
istex:99FFA6075728C8D136E69F76A8627FCDAD8BEED7
Descrição: Background. Since 2002, an epidemic of Clostridium difficile–associated-diarrhea (CDAD) associated with a high case-fatality rate has involved >30 hospitals in the province of Quebec, Canada. In 2003, a total of 55% of patients with CDAD at our hospital had received fluoroquinolones in the preceding 2 months. It has been suggested that massive use of proton pump inhibitors might have facilitated this epidemic. Methods. To delineate the risk of CDAD associated with specific classes of antibiotics and whether this is modulated by concomitant use of proton pump inhibitors and other drugs altering gastric acidity or gastrointestinal motility, we conducted a retrospective cohort study of patients hospitalized in a teaching hospital in Sherbrooke, Canada, during the period of January 2003 through June 2004. We obtained data on 7421 episodes of care corresponding to 5619 individuals. Patients were observed until they either developed CDAD or died or for 60 days after discharge from the hospital. Adjusted hazard ratios (AHRs) were calculated using Cox regression. Results. CDAD occurred in 293 patients. Fluoroquinolones were the antibiotics most strongly associated with CDAD (AHR, 3.44; 95% confidence interval [CI], 2.65–4.47). Almost one-fourth of all inpatients received quinolones, for which the population-attributable fraction of CDAD was 35.9%. All 3 generations of cephalosporins, macrolides, clindamycin, and intravenous β-lactam/β-lactamase inhibitors were intermediate-risk antibiotics, with similar AHRs (1.56–1.89). Proton pump inhibitors (AHR, 1.00, 95% CI, 0.79–1.28) were not associated with CDAD. Conclusions. Administration of fluoroquinolones emerged as the most important risk factor for CDAD in Quebec during an epidemic caused by a hypervirulent strain of C. difficile.
Editor: Chicago, IL: The University of Chicago Press
Idioma: Inglês

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Emergence of Fluoroquinolones as the Predominant Risk Factor for Clostridium difficile–Associated Diarrhea: A Cohort Study during an Epidemic in Quebec

Pépin, Jacques ; Saheb, Nathalie ; Coulombe, Marie-Andrée ; Alary, Marie-Eve ; Corriveau, Marie-Pier ; Authier, Simon ; Leblanc, Michel ; Rivard, Geneviève ; Bettez, Mathieu ; Primeau, Valérie ; Nguyen, Martin ; Jacob, Claude-Émilie ; Lanthier, Luc

Chicago, IL: The University of Chicago Press

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