Antibiotics and the risk of community-associated Clostridium difficile infection (CDI): a meta-analysis

The rising incidence of Clostridium difficile infection (CDI) could be reduced by lowering exposures to high risk antibiotics. The objective of this study was to determine the association between antibiotic class and the risk of CDI in the community setting. EMBASE and PubMed were queried without restriction to date or language. Comparative observational studies and RCTs considering the impact of antibiotic exposures on CDI risk among non-hospitalized populations were considered. We estimated pooled odds ratios (OR) for antibiotic classes using random effects meta-analysis. Our search criteria identified 465 articles, of which 7 met inclusion criteria; all were observational studies. Five studies considered antibiotic risk relative to no antibiotic exposure: clindamycin (OR=16.80, 95% confidence interval [CI]: 7.48-37.76), fluoroquinolones (OR=5.50, 95% CI: 4.26-7.11) and cephalosporins, monobactams and carbapenems (CMCs, OR=5.68, 95% CI: 2.12-15.23) had the largest effects, while macro...