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Diarrhoea - antibiotic associated - Background information
What are the risk factors?
- Major risk factors for Clostridium difficile infection are:
- Advanced age — the rate of positive C. difficile assay in people older than 60 years of age is 20–100 times greater than the rate in people 10–20 years of age.
- Treatment with an antibiotic. Although none can be excluded, the most commonly implicated antibiotics are:
- Ampicillin and amoxicillin (with or without clavulanic acid).
- Clindamycin.
- Cephalosporins — in particular second- and third-generation cephalosporins (such as cefuroxime axetil, cefixime, ceftriaxone, and cefotaxime).
- Fluoroquinolones (such as ciprofloxacin, norfloxacin). Recent strains of C. difficile (such as 027) are resistant to quinolones, which make them a major cause of C. difficile infection.
- Long duration of antibiotic treatment.
- Multiple antibiotics prescribed concurrently, or multiple antibiotic courses prescribed.
- Hospitalization — rates of colonization are about three times higher in hospitalized people than in those treated as outpatients.
- Exposure to other cases — C. difficile infection can occur in outbreaks.
- Current use of a proton pump inhibitor (such as omeprazole and lansoprazole) or other acid-suppressive drugs (such as H2-receptor antagonists).
- Severe underlying disease.
- Presence of a nasogastric tube.
- Non-surgical gastrointestinal procedures.
- History of C. difficile infection — between 20–25% of people experience recurrence of symptoms after the initial episode of C. difficile has resolved.
[Bartlett, 2002; Hurley and Nguyen, 2002; Starr, 2005; HPA, 2007b; Bartlett and Gerding, 2008; DH and HPA, 2008; Owens et al, 2008; Williams and Spencer, 2009]
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