JAC Advance Access published online on May 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg254
© 2003 by The British Society for Antimicrobial Chemotherapy
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Review
1 School of Biomedical and
Chemical Sciences, The University of Western Australia, Queen Elizabeth
II Medical Centre, Nedlands, Perth; School of Population Health, The University of
Western Australia, Clifton Street, Nedlands, Perth
* Corresponding author. E-mail: c-thomas{at}cyllene.uwa.edu.au.
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
Antibiotics and hospital-acquired Clostridium
difficile-associated diarrhoea: a systematic review
2 School of Population Health, The University of
Western Australia, Clifton Street, Nedlands, Perth
3 School of Biomedical and
Chemical Sciences, The University of Western Australia, Queen Elizabeth
II Medical Centre, Nedlands, Perth; Division of Microbiology, The West
Australian Centre for Pathology and Medical Research, Nedlands,
Perth, Western Australia, 6009
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