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JAC Advance Access originally published online on May 13, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 1339-1350
© 2003 The British Society for Antimicrobial Chemotherapy

Review Article

Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review

Claudia Thomas1,2,*, Mark Stevenson2 and Thomas V. Riley1,3

1 School of Biomedical and Chemical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Perth; 2 School of Population Health, The University of Western Australia, Clifton Street, Nedlands, Perth; 3 Division of Microbiology, The West Australian Centre for Pathology and Medical Research, Nedlands, Perth, Western Australia, 6009

A systematic review of studies that investigated the association of antibiotics with hospital-acquired Clostridium difficile-associated diarrhoea (CDAD) was undertaken to summarize the strength of the evidence for this relationship. The results from the studies identified were considered after critically reviewing the design and conduct of each study. Although the majority of studies found an association with various antibiotics, antibiotic classes or components of antibiotic administration, most were limited in their ability to establish a causal relationship by the use of incorrect control groups, the presence of bias, inadequate control of confounding and small sample sizes. The limitations identified in this review prevented the pooling of results in a meta-analysis. Two studies of reasonable quality suggested an association between clindamycin, cephalosporins, penicillins and CDAD. Well-designed studies grounded in epidemiological principles are needed to identify true risk factors for CDAD and to provide reliable estimates of the strength of association.

Keywords: Clostridium difficile, systematic review

* Correspondence address. School of Biomedical and Chemical Sciences, The University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia, 6009. Tel: +618-9346-3440; Fax: +618-9382-8046; E-mail: c-thomas{at}cyllene.uwa.edu.au


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