{"id":28972,"date":"2025-09-29T04:24:00","date_gmt":"2025-09-28T20:24:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28972"},"modified":"2025-09-29T05:43:14","modified_gmt":"2025-09-28T21:43:14","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8a%97%e7%94%9f%e7%b4%a0%e4%bd%bf%e7%94%a8%e4%b8%8e%e5%8c%bb%e9%99%a2%e5%8f%91%e7%94%9f%e7%9a%84%e9%9a%be%e8%be%a8%e6%a2%ad%e7%8a%b6","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28972","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u6297\u751f\u7d20\u4f7f\u7528\u4e0e\u533b\u9662\u53d1\u751f\u7684\u96be\u8fa8\u68ad\u72b6\u82bd\u5b62\u6746\u83cc\u611f\u67d3\u98ce\u9669"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Infectious Diseases<\/p>\n\n\n\n

Antibiotic Use and the Risk of Hospital-Onset Clostridioides Difficile<\/em> Infection<\/h1>\n\n\n\n

Mayan\u00a0Gilboa,\u00a0Gili\u00a0Regev-Yochay,\u00a0Eyal\u00a0Meltzer,\u00a0et al<\/h3>\n\n\n\n

JAMA Netw Open Published Online:\u00a0August\u00a08,\u00a02025<\/h3>\n\n\n\n

2025;8;(8):e2525252.\u00a0doi:10.1001\/jamanetworkopen.2025.25252<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the hazard of Clostridioides difficile<\/em> infection (CDI) between asymptomatic carriers compared with noncarriers of C difficile<\/em>, and is this hazard associated with antibiotic exposure?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 33\u202f756 hospitalizations among 23 001 patients, asymptomatic carriers had a higher hazard of CDI. Antibiotic exposure, particularly to amoxicillin and clavulanate and piperacillin and tazobactam, was associated with an increased hazard of CDI, especially among noncarriers, with no additional hazard among carriers.<\/p>\n\n\n\n

Meaning<\/strong>  These findings suggest that while antibiotic stewardship may be associated with a reduced hazard of CDI in asymptomatic carriers given their already elevated hazard, additional strategies may be warranted.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Clostridioides difficile<\/em> is a leading cause of health care\u2013associated infections. Understanding the association among C difficile<\/em> carriage, antibiotic use, and infection hazard is essential for infection prevention.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate the hazard of C difficile<\/em> infection (CDI) among asymptomatic carriers vs noncarriers of C difficile<\/em> and whether it is associated with antibiotic exposure.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This retrospective cohort study conducted between June 18, 2017, and June 21, 2023, analyzed hospitalizations from Sheba Medical Center in Ramat Gan, Israel, which routinely screens for C difficile<\/em> in high-risk patients admitted to internal medicine. Adult patients (aged >18 years) without active CDI at admission were included.<\/p>\n\n\n\n

Exposure<\/strong>  Antibiotic exposure during hospitalization, including specific classes.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was the development of CDI, as confirmed by laboratory testing for C difficile<\/em>. Antibiotic exposure was assessed as a time-varying variable.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0The study included 33\u202f756 hospitalizations among 23\u202f001 patients (median [IQR] age, 78 [68-87] years; 52.8% men).\u00a0C difficile<\/em>\u00a0infection occurred in 67 of 1624 hospitalizations (4.1%) with positive screening results and in 47 of 32 132 hospitalizations (0.1%) with negative screening results. A positive\u00a0C difficile<\/em>\u00a0screening result at admission was associated with a high hazard of infection (hazard ratio [HR], 27.5; 95% CI, 18.7-40.3). Antibiotic exposure was associated with an increased hazard for CDI (HR, 1.98; 95% CI, 1.24-3.16). Piperacillin and tazobactam showed the most pronounced hazard for CDI (HR, 2.18; 95% CI, 1.41-3.36). Among asymptomatic carriers, antibiotic exposure was not significantly associated with a further increase in CDI hazard (HR, 1.07; 95% CI, 0.73-1.58).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this cohort study, carriers of C difficile<\/em> had a substantially higher baseline hazard for hospital-onset CDI. Antibiotic exposure was associated with an increased hazard among noncarriers but was not significantly associated with additional hazard among carriers. These findings suggest that while antibiotic stewardship may reduce CDI risk in noncarriers, additional strategies may be needed for carriers given their elevated baseline risk.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Infectious Diseases Antibi […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28972"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28972"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28972\/revisions"}],"predecessor-version":[{"id":28973,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28972\/revisions\/28973"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28972"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28972"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28972"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}