Dataset Information

Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations.

ABSTRACT:

Objective

To describe risk of Clostridium difficile infection associated with clindamycin and acute kidney injury associated with gentamicin during delivery hospitalizations.

Methods

Women admitted for delivery from January 2006 to March 2015 were analyzed using an inpatient administrative database. Primary outcomes were C difficile infection and acute kidney injury. C difficile infection was compared between women receiving clindamycin (with or without other antibiotics) and women receiving antibiotics other than clindamycin. Acute kidney injury was compared between women receiving gentamicin (with or without other antibiotics), women receiving antibiotics other than gentamicin, and women receiving no antibiotics. Unadjusted and adjusted log linear models analyzing the role of patient demographics, mode of delivery, and hospital-level characteristics were created evaluating risk of C difficile infection and acute kidney injury with risk ratios (RRs) and adjusted risk ratios with 99% CIs as measures of association. A sensitivity analysis for gentamicin and acute kidney injury was performed restricted to women with preeclampsia.

Results

Of 5,657,523 women admitted for delivery hospitalization, 266,402 (4.7%) received clindamycin and 165,726 (2.9%) received gentamicin. C difficile infection was diagnosed in 0.04% of women receiving clindamycin. Compared with women receiving other antibiotics, clindamycin was associated with a nearly threefold increased risk of C difficile infection (RR 2.93, 99% CI 2.21-3.90). Acute kidney injury was diagnosed in 0.24% of women receiving gentamicin. Gentamicin was associated with a threefold increased risk of acute kidney injury (RR 3.01, 99% CI 2.62-3.45) compared with women receiving other antibiotics, whereas receipt of no antibiotics was associated with significantly lower risk (RR 0.18, 99% CI 0.15-0.20). In adjusted analyses, these associations retained significance. Significantly increased risk of acute kidney injury was noted for women with preeclampsia receiving gentamicin (RR 2.04, 99% CI 1.64-2.53).

Conclusion

Receipt of clindamycin was associated with significantly increased likelihood for C difficile infection and receipt of gentamicin with significantly increased likelihood of acute kidney injury, although the absolute risk of these complications was low.

SUBMITTER: Duffy CR

PROVIDER: S-EPMC6923533 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations.

Duffy Cassandra R CR Huang Yongmei Y Andrikopoulou Maria M Stern-Ascher Conrad N CN Wright Jason D JD Goffman Dena D D'Alton Mary E ME Friedman Alexander M AM

Obstetrics and gynecology 20200101 1

<h4>Objective</h4>To describe risk of Clostridium difficile infection associated with clindamycin and acute kidney injury associated with gentamicin during delivery hospitalizations.<h4>Methods</h4>Women admitted for delivery from January 2006 to March 2015 were analyzed using an inpatient administrative database. Primary outcomes were C difficile infection and acute kidney injury. C difficile infection was compared between women receiving clindamycin (with or without other antibiotics) and wome ...[more]

PMID: 31809424

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Project description:OBJECTIVE: To examine the rate of Clostridium difficile infection (CDI) and hospital-associated outcomes in a national cohort of hospitalized patients with chronic kidney disease (CKD) and assess the impact of long-term dialysis on outcome in these patients. PATIENTS AND METHODS: Data for January 1, 2005, through December 31, 2009 were obtained from the National Hospital Discharge Survey, which includes information on patient demographics, diagnoses, procedures, and discharge types. Data collected and analyzed for this study included age, sex, race, admission type (urgent or emergent combined vs elective), any colectomy diagnosis, length of stay, type of discharge, and mortality. International Classification of Diseases, Ninth Revision, Clinical Modification codes were utilized to identify CKD patients and CDI events. Weighted analysis was performed using JMP version 9. RESULTS: An estimated 162 million adults were hospitalized during 2005-2009, and 8.03 million (5%) had CKD (median age, 71 years). The CDI rate in CKD patients was 1.49% (0.119 million) compared with 0.70% (1.14 million) in patients without CKD (P<.001). Patients with CKD who were undergoing long-term dialysis were more than 2 times as likely to develop CDI than non-CKD patients and 1.33 times more likely than CKD patients not undergoing dialysis (all P<.001). In a weighted multivariate analysis adjusting for sex and comorbidities, patients with CKD and CDI had longer hospitalization, higher colectomy rate (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 2.14-2.47), dismissal to a health care facility (aOR, 2.22; 95% CI, 2.19-2.25), and increased in-hospital mortality (aOR, 1.55; 95% CI, 1.52-1.59; all P<.001) as compared with CKD patients without CDI. Patients with CKD who were undergoing long-term dialysis did not have worse outcomes as compared with CKD patients who were not undergoing long-term dialysis. CONCLUSION: These data suggest that patients with CKD have a higher risk of CDI and increased hospital-associated morbidity and mortality. Future prospective studies are needed to confirm these findings and to identify effective CDI prevention in CKD patients, who appear to have an increased risk of CDI acquisition.

Project description:BackgroundThere is a paucity of contemporary national estimates for Clostridium difficile infection (CDI) hospitalizations by age group, sex, and region in the US population. Also, there is lack of contemporary national statistics on CDI hospitalizations with comorbidities.MethodsWe analyzed the 2017 National Inpatient Sample (NIS) to determine the population-based rates of CDI hospitalizations, characteristics of hospitalizations with CDI, and the rates of comorbidities associated with CDI hospitalizations.ResultsThere were 329,460 CDI-related hospitalizations in 2017 (almost 1% of all hospitalizations). The average age for patients admitted with CDI as a principal or secondary diagnosis was 64.7 years (almost 20 years older when compared with all other hospitalizations). Patients 85 years and older had the highest rate of CDI hospitalizations (716 per 100,000 hospitalizations), and patients less than 18 years of age had the lowest rate (12 per 100,000 hospitalizations). There was a progressive increase in the CDI hospitalization rates with each successive age group. The hospitalization rates were higher in females (114 per 100,000 hospitalizations) than males (88 per 100,000 hospitalizations). The CDI hospitalization rate was highest in the Northeast (109 per 100,000 hospitalizations) and lowest in the West (84 per 100,000 hospitalizations). Fluid and electrolyte disturbance (63.3%) and renal failure (33.4%) were the two most common comorbidities associated with CDI hospitalizations. When CDI is a secondary diagnosis, major loss of function, extreme likelihood of dying, septicemia, and septic shock were more common in comparison to CDI as a principal diagnosis.ConclusionsCDI hospitalization rates were highest in the elderly over 85 years old and declined with successive decreases in age. Women had higher CDI hospitalization rates than men, and fluid and electrolyte disturbances and renal failure were the most common comorbid conditions. The presence of CDI as a comorbid condition at the time of hospitalization for other principal diagnoses or development of CDI during a hospitalization for other principal diagnoses significantly increases the risk of in-hospital morbidity and mortality.

Dataset Information

Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations.

Objective

Methods

Results

Conclusion

Publications

Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations.

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