A 2014 systematic review of the association between CDAD and antibiotics in hospitalized patients included 13 case-control studies and 1 cohort study with nearly 16,000 total participants. The highest risk was seen with third-generation cephalosporins (OR, 3.20 [CI, 1.80 to 5.71]), followed by clindamycin (OR, 2.86 [CI, 2.04 to 4.02]), second-generation cephalosporins (OR, 2.23 [CI, 1.47 to 3.37]), and fourth-generation cephalosporins (OR, 2.14 [CI, 1.30 to 3.52]) (3).
A 2013 systematic review of the association between antibiotic use and community-acquired CDAD included eight studies with more than 30,000 participants. Overall, exposure to antibiotics was associated with CDAD (OR, 6.91 [CI, 4.17 to 11.44]). The greatest risk was seen with clindamycin (OR, 20.43 [CI, 8.50 to 49.09]), followed by fluoroquinolones (OR, 5.65 [CI, 4.38 to 7.28]) and cephalosporins (OR, 4.47 [CI, 1.60 to 12.50]). Tetracyclines were not associated with CDAD (OR, 0.91 [CI, 0.57 to 1.45]) and trimethoprim-sulfamethoxazole was associated with a small increase in risk (OR, 1.84 [CI, 1.48 to 2.29]) (4).
A 2013 systematic review of the association between CDAD and the use of different antibiotics in the community included seven studies. Compared with no antibiotic exposure, clindamycin (OR, 16.80 [CI, 7.48 to 37.76]), fluoroquinolones (OR, 5.50 [CI, 4.26 to 7.11]), and cephalosporins, carbapenems, and monobactams (OR, 5.68 [CI, 2.12 to 15.23]) were most strongly associated with CDAD. Tetracyclines did not increase the risk for CDAD; macrolides, penicillins, and sulfonamides/trimethoprim were associated with lower risk (5).
A 2012 systematic review of the association between proton-pump inhibitors and CDAD included 23 studies with nearly 300,000 participants. Overall, patients receiving proton-pump inhibitors were at increased risk for CDAD (RR, 1.69 [CI, 1.40 to 1.97]) (28).
A 2012 systematic review of the relationship between proton-pump inhibitors and CDAD included 30 observational studies. Proton-pump inhibitors significantly increased the risk for CDAD (OR, 2.5 [CI, 1.81 to 2.55]) (29).
A 2012 systematic review of the risk for CDAD with acid-suppressing drugs and antibiotics included 42 observational studies with a total of 313,000 participants. The use of proton-pump inhibitors increased the risk for developing CDAD (OR, 1.74 [CI, 1.47 to 2.85]; P<0.0010), with lower risk from H2-receptor antagonists than from proton-pump inhibitors (OR, 0.71 [CI, 0.53 to 0.97]). The use of proton-pump inhibitors plus antibiotics resulted in higher rates of CDAD than the use of proton-pump inhibitors alone (OR, 1.96 [CI, 1.03 to 3.70]) (30).
A 1998 systematic review of risk factors for CDAD included 49 studies; formal quality assessment of the evidence was not performed. Overall, older age, underlying severe disease, antiulcer medication, nasogastric tube placement, antibiotics, and length of hospital stay were associated with CDAD (31).
A large case-control study evaluated risk factors for CDAD among U.S. veterans. Patients with CDAD were older, more likely to have multiple comorbid conditions, and more likely to be white (32).
A case-control study evaluated the association between obesity and CDAD in hospitalized patients. In the multivariate model, a higher BMI (OR, 1.196 per 1–unit increase in BMI [CI, 1.120 to 1.270]) and a history of intra-abdominal surgery (OR, 2.87 [CI, 1.26 to 6.52]) were associated with CDAD (33).
A 2008 narrative review discussed the diagnosis of CDAD (34).