Impact of Antibiotic Therapy on Clostridioides Difficile Infection in Hospitals

Clostridioides difficile is one of the leading causes of healthcare-associated infections, and understanding its relationship with carriage and antibiotic use was critical for infection prevention. 

A recent study published in Infectious Diseases (JAMA Network Open) evaluated the risk of C. difficile infection (CDI) among asymptomatic carriers compared with noncarriers and examined the role of antibiotic exposure. 

A retrospective cohort analysis was conducted at Sheba Medical Center, Israel, between June 2017 and June 2023. Adult patients admitted to internal medicine without active CDI at admission were included. High-risk patients were routinely screened for C. difficile.

Antibiotic exposure during hospitalization was recorded, including specific drug classes, and CDI development was confirmed by laboratory testing. Among 33,756 hospitalizations of 23,001 patients (median age 78 years; 52.8% men), CDI occurred in 67 of 1,624 hospitalizations (4.1%) with positive screening results and in 47 of 32,132 hospitalizations (0.1%) with negative results. A positive C. difficile screening result at admission was associated with a markedly increased risk of infection (HR 27.5, 95% CI 18.7–40.3).

Antibiotic exposure also increased CDI hazard overall (HR 1.98, 95% CI 1.24–3.16), with piperacillin-tazobactam showing the highest risk (HR 2.18, 95% CI 1.41–3.36). Among carriers, antibiotics did not raise infection risk significantly (HR 1.07, 95% CI 0.73–1.58).

These results indicated that C. difficile carriers had a high baseline risk for hospital-onset CDI. Antibiotic stewardship reduced risk in noncarriers, but additional preventive strategies were needed for carriers due to their elevated baseline hazard.

Reference:

1. Gilboa M, Regev-Yochay G, Meltzer E, et al. Antibiotic use and the risk of hospital-onset Clostridioides difficile infection. JAMA Netw Open. 2025;8(8):e2525252. doi:10.1001/jamanetworkopen.2025.2525. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837369