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Do piperacillin/tazobactam and other antibiotics with inhibitory activity against Clostridium difficile reduce the risk for acquisition of C. difficile colonization?

Kundrapu S, Sunkesula VC, Jury LA, Cadnum JL, Nerandzic MM, Musuuza JS, Sethi AK, Donskey CJ - BMC Infect. Dis. (2016)

Bottom Line: For a subset of patients, in vitro inhibition of C. difficile (defined as a reduction in concentration after inoculation of vegetative C. difficile into fresh stool suspensions) was compared among antibiotic treatment groups.Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics.Our findings suggest that piperacillin/tazobactam achieves sufficient concentrations in the intestinal tract to inhibit C. difficile colonization during therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Infectious Diseases Division, Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA.

ABSTRACT

Background: Systemic antibiotics vary widely in in vitro activity against Clostridium difficile. Some agents with activity against C. difficile (e.g., piperacillin/tazobactam) inhibit establishment of colonization in mice. We tested the hypothesis that piperacillin/tazobactam and other agents with activity against C. difficile achieve sufficient concentrations in the intestinal tract to inhibit colonization in patients.

Methods: Point-prevalence culture surveys were conducted to compare the frequency of asymptomatic rectal carriage of toxigenic C. difficile among patients receiving piperacillin/tazobactam or other inhibitory antibiotics (e.g. ampicillin, linezolid, carbapenems) versus antibiotics lacking activity against C. difficile (e.g., cephalosporins, ciprofloxacin). For a subset of patients, in vitro inhibition of C. difficile (defined as a reduction in concentration after inoculation of vegetative C. difficile into fresh stool suspensions) was compared among antibiotic treatment groups.

Results: Of 250 patients, 32 (13 %) were asymptomatic carriers of C. difficile. In comparison to patients receiving non-inhibitory antibiotics or prior antibiotics within 90 days, patients currently receiving piperacillin/tazobactam were less likely to be asymptomatic carriers (1/36, 3 versus 7/36, 19 and 15/69, 22 %, respectively; P = 0.024) and more likely to have fecal suspensions with in vitro inhibitory activity against C. difficile (20/28, 71 versus 3/11, 27 and 4/26, 15 %; P = 0.03). Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics.

Conclusions: Our findings suggest that piperacillin/tazobactam achieves sufficient concentrations in the intestinal tract to inhibit C. difficile colonization during therapy.

No MeSH data available.


Related in: MedlinePlus

Frequency of asymptomatic carriage of toxigenic Clostridium difficile in hospitalized patients, stratified by antibiotic treatment classification. Based upon a modification of the classification scheme of Owens et al. [1], antibiotics on the formulary that were classified as having inhibitory activity against C. difficile included ampicillin, amoxicillin, linezolid, metronidazole, imipenem, meropenem, piperacillin/tazobactam, tigecycline, and tetracyclines. Antibiotics on the formulary that were considered to have poor activity included cephalosporins, ciprofloxacin, and trimethoprim/sulfamethoxazole. Moxifloxacin was classified as having variable activity against C. difficile
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Fig1: Frequency of asymptomatic carriage of toxigenic Clostridium difficile in hospitalized patients, stratified by antibiotic treatment classification. Based upon a modification of the classification scheme of Owens et al. [1], antibiotics on the formulary that were classified as having inhibitory activity against C. difficile included ampicillin, amoxicillin, linezolid, metronidazole, imipenem, meropenem, piperacillin/tazobactam, tigecycline, and tetracyclines. Antibiotics on the formulary that were considered to have poor activity included cephalosporins, ciprofloxacin, and trimethoprim/sulfamethoxazole. Moxifloxacin was classified as having variable activity against C. difficile

Mentions: Figure 1 shows a comparison of the frequency of asymptomatic carriage of C. difficile, stratified by antibiotic treatment category. In comparison to patients receiving non-inhibitory antibiotics or prior antibiotics within 90 days, patients receiving current piperacillin/tazobactam were significantly less likely to be carriers of C. difficile (3 versus 18 and 22 %, respectively; P ≤ 0.02). Six of the 14 (43 %) patients with C. difficile carriage who had received prior antibiotics within 90 days had received regimens that included piperacillin/tazobactam. For the 6 patients who had received prior piperacillin/tazobactam, the mean number of days since the last dose of piperacillin/tazobactam was 7.5 (range, 2 to 14 days); for the 8 patients who received prior antibiotics other than piperacillin/tazobactam, the mean number of days since the last dose of antibiotics was 7.1 (range, 1 to 21 days). Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics. Patients who had not received antibiotic therapy within the past 90 days were infrequently colonized with C. difficile.Fig. 1


Do piperacillin/tazobactam and other antibiotics with inhibitory activity against Clostridium difficile reduce the risk for acquisition of C. difficile colonization?

Kundrapu S, Sunkesula VC, Jury LA, Cadnum JL, Nerandzic MM, Musuuza JS, Sethi AK, Donskey CJ - BMC Infect. Dis. (2016)

Frequency of asymptomatic carriage of toxigenic Clostridium difficile in hospitalized patients, stratified by antibiotic treatment classification. Based upon a modification of the classification scheme of Owens et al. [1], antibiotics on the formulary that were classified as having inhibitory activity against C. difficile included ampicillin, amoxicillin, linezolid, metronidazole, imipenem, meropenem, piperacillin/tazobactam, tigecycline, and tetracyclines. Antibiotics on the formulary that were considered to have poor activity included cephalosporins, ciprofloxacin, and trimethoprim/sulfamethoxazole. Moxifloxacin was classified as having variable activity against C. difficile
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835867&req=5

Fig1: Frequency of asymptomatic carriage of toxigenic Clostridium difficile in hospitalized patients, stratified by antibiotic treatment classification. Based upon a modification of the classification scheme of Owens et al. [1], antibiotics on the formulary that were classified as having inhibitory activity against C. difficile included ampicillin, amoxicillin, linezolid, metronidazole, imipenem, meropenem, piperacillin/tazobactam, tigecycline, and tetracyclines. Antibiotics on the formulary that were considered to have poor activity included cephalosporins, ciprofloxacin, and trimethoprim/sulfamethoxazole. Moxifloxacin was classified as having variable activity against C. difficile
Mentions: Figure 1 shows a comparison of the frequency of asymptomatic carriage of C. difficile, stratified by antibiotic treatment category. In comparison to patients receiving non-inhibitory antibiotics or prior antibiotics within 90 days, patients receiving current piperacillin/tazobactam were significantly less likely to be carriers of C. difficile (3 versus 18 and 22 %, respectively; P ≤ 0.02). Six of the 14 (43 %) patients with C. difficile carriage who had received prior antibiotics within 90 days had received regimens that included piperacillin/tazobactam. For the 6 patients who had received prior piperacillin/tazobactam, the mean number of days since the last dose of piperacillin/tazobactam was 7.5 (range, 2 to 14 days); for the 8 patients who received prior antibiotics other than piperacillin/tazobactam, the mean number of days since the last dose of antibiotics was 7.1 (range, 1 to 21 days). Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics. Patients who had not received antibiotic therapy within the past 90 days were infrequently colonized with C. difficile.Fig. 1

Bottom Line: For a subset of patients, in vitro inhibition of C. difficile (defined as a reduction in concentration after inoculation of vegetative C. difficile into fresh stool suspensions) was compared among antibiotic treatment groups.Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics.Our findings suggest that piperacillin/tazobactam achieves sufficient concentrations in the intestinal tract to inhibit C. difficile colonization during therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Infectious Diseases Division, Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA.

ABSTRACT

Background: Systemic antibiotics vary widely in in vitro activity against Clostridium difficile. Some agents with activity against C. difficile (e.g., piperacillin/tazobactam) inhibit establishment of colonization in mice. We tested the hypothesis that piperacillin/tazobactam and other agents with activity against C. difficile achieve sufficient concentrations in the intestinal tract to inhibit colonization in patients.

Methods: Point-prevalence culture surveys were conducted to compare the frequency of asymptomatic rectal carriage of toxigenic C. difficile among patients receiving piperacillin/tazobactam or other inhibitory antibiotics (e.g. ampicillin, linezolid, carbapenems) versus antibiotics lacking activity against C. difficile (e.g., cephalosporins, ciprofloxacin). For a subset of patients, in vitro inhibition of C. difficile (defined as a reduction in concentration after inoculation of vegetative C. difficile into fresh stool suspensions) was compared among antibiotic treatment groups.

Results: Of 250 patients, 32 (13 %) were asymptomatic carriers of C. difficile. In comparison to patients receiving non-inhibitory antibiotics or prior antibiotics within 90 days, patients currently receiving piperacillin/tazobactam were less likely to be asymptomatic carriers (1/36, 3 versus 7/36, 19 and 15/69, 22 %, respectively; P = 0.024) and more likely to have fecal suspensions with in vitro inhibitory activity against C. difficile (20/28, 71 versus 3/11, 27 and 4/26, 15 %; P = 0.03). Patients receiving other inhibitory antibiotics were not less likely to be asymptomatic carriers than those receiving non-inhibitory antibiotics.

Conclusions: Our findings suggest that piperacillin/tazobactam achieves sufficient concentrations in the intestinal tract to inhibit C. difficile colonization during therapy.

No MeSH data available.


Related in: MedlinePlus