{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T20:45:26Z","timestamp":1771879526851,"version":"3.50.1"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X22000605_as1\"><jats:title>Objective:<\/jats:title><jats:p><jats:italic>Clostridioides difficile<\/jats:italic> infection (CDI) is the most common cause of gastroenteritis, and community-acquired pneumonia (CAP) is the most common infection treated in hospitals. American Thoracic Society (ATS)\/Infectious Diseases Society of America (IDSA) CAP guidelines recommend empiric therapy with a respiratory fluoroquinolone or cephalosporin plus macrolide combination, but the CDI risk of these regimens is unknown. We examined the association between each antibiotic regimen and the development of hospital-onset CDI.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22000605_as2\"><jats:title>Methods:<\/jats:title><jats:p>We conducted a retrospective cohort study using data from 638 US hospitals contributing administrative including 177 also contributing microbiologic data to Premier, Inc. We included adults admitted with pneumonia and discharged from July 2010 through June 2015 with a pneumonia diagnosis code who received \u22653 days of either empiric regimen. Hospital-onset CDI was defined by a diagnosis code not present on admission and positive laboratory test on day 4 or later or readmission for CDI. Mixed propensity-weighted multiple logistic regression was used to estimate the associations of CDI with antibiotic regimens.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22000605_as3\"><jats:title>Results:<\/jats:title><jats:p>Our sample included 58,060 patients treated with either cephalosporin plus macrolide (36,796 patients) or a fluoroquinolone alone (21,264 patients) and with microbiological data; 127 (0.35%) patients who received cephalosporin plus macrolide and 65 (0.31%) who received a fluoroquinolone developed CDI. After adjustment for patient demographics, comorbidities, risk factors for antimicrobial resistance, and hospital characteristics, CDI risks were similar for fluoroquinolones versus cephalosporin plus macrolide (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.70\u20131.38).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22000605_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Among patients with CAP at US hospitals, CDI was uncommon, occurring in \u223c0.33% of patients. We did not detect a significant association between the choice of empiric guideline recommended antibiotic therapy and the development of CDI.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2022.60","type":"journal-article","created":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T08:42:19Z","timestamp":1650444139000},"page":"47-54","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Association of fluoroquinolones or cephalosporin plus macrolide with <i>Clostridioides difficile<\/i> infection (CDI) after treatment for community-acquired pneumonia"],"prefix":"10.1017","volume":"44","author":[{"given":"Preethi","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-2995","authenticated-orcid":false,"given":"Abhishek","family":"Deshpande","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8830-8733","authenticated-orcid":false,"given":"Pei-Chun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0533-4603","authenticated-orcid":false,"given":"Peter B.","family":"Imrey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter K.","family":"Lindenauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marya D.","family":"Zilberberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Haessler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"S0899823X22000605_ref13","unstructured":"13. Premier Healthcare database: data that informs and performs. Premier website. https:\/\/products.premierinc.com\/downloads\/PremierHealthcareDatabaseWhitepaper.pdf. Published 2020. Accessed March 15, 2022."},{"key":"S0899823X22000605_ref5","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-0925-9"},{"key":"S0899823X22000605_ref17","doi-asserted-by":"publisher","DOI":"10.1086\/650447"},{"key":"S0899823X22000605_ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408913"},{"key":"S0899823X22000605_ref23","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy035"},{"key":"S0899823X22000605_ref6","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02176-12"},{"key":"S0899823X22000605_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2017.12.014"},{"key":"S0899823X22000605_ref4","unstructured":"4. Pfuntner, A , Wier, LM , Stocks, C. Most frequent conditions in US hospitals, 2011: statistical brief #162. 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