{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:20:59Z","timestamp":1790709659929,"version":"4.1.0"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2013,5,1]],"date-time":"2013-05-01T00:00:00Z","timestamp":1367366400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The rising incidence of\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Clostridium difficile<\/jats:named-content>\n            infection (CDI) could be reduced by lowering exposure 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. The EMBASE and PubMed databases were queried without restriction to time period or language. Comparative observational studies and randomized controlled trials (RCTs) considering the impact of exposure to antibiotics on CDI risk among nonhospitalized populations were considered. We estimated pooled odds ratios (OR) for antibiotic classes using random-effect 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 [95% CI], 7.48 to 37.76), fluoroquinolones (OR = 5.50; 95% CI, 4.26 to 7.11), and cephalosporins, monobactams, and carbapenems (CMCs) (OR = 5.68; 95% CI, 2.12 to 15.23) had the largest effects, while macrolides (OR = 2.65; 95% CI, 1.92 to 3.64), sulfonamides and trimethoprim (OR = 1.81; 95% CI, 1.34 to 2.43), and penicillins (OR = 2.71; 95% CI, 1.75 to 4.21) had lower associations with CDI. We noted no effect of tetracyclines on CDI risk (OR = 0.92; 95% CI, 0.61 to 1.40). In the community setting, there is substantial variation in the risk of CDI associated with different antimicrobial classes. Avoidance of high-risk antibiotics (such as clindamycin, CMCs, and fluoroquinolones) in favor of lower-risk antibiotics (such as penicillins, macrolides, and tetracyclines) may help reduce the incidence of CDI.\n          <\/jats:p>","DOI":"10.1128\/aac.02176-12","type":"journal-article","created":{"date-parts":[[2013,3,12]],"date-time":"2013-03-12T01:07:32Z","timestamp":1363050452000},"page":"2326-2332","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":525,"title":["Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection"],"prefix":"10.1128","volume":"57","author":[{"given":"Kevin A.","family":"Brown","sequence":"first","affiliation":[{"name":"Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagham","family":"Khanafer","sequence":"additional","affiliation":[{"name":"Laboratoire de Biom\u00e9trie et de Biologie \u00c9volutive, Universit\u00e9 de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David N.","family":"Fisman","sequence":"additional","affiliation":[{"name":"Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","volume-title":"Ontario Burden of Infectious Disease Study (ONBOIDS): an OAHPP\/ICES report.","author":"Kwong J","year":"2010","unstructured":"KwongJ CrowcroftN CampitelliM DanemanN DeeksS ManuelD. 2010. Ontario Burden of Infectious Disease Study (ONBOIDS): an OAHPP\/ICES report. Ontario Agency for Health Protection and Promotion and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.10.1092"},{"key":"e_1_3_2_4_2","first-page":"1201","article-title":"Severe Clostridium difficile-associated disease in populations previously at low risk\u2013four states, 2005","volume":"54","author":"Centers for Disease Control and Prevention","year":"2005","unstructured":"Centers for Disease Control and Prevention. 2005. Severe Clostridium difficile-associated disease in populations previously at low risk\u2013four states, 2005. Morb. Mortal. Wkly. Rep. 54:1201\u20131205.","journal-title":"Morb. Mortal. Wkly. 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