Beware of Cephalosporins and the Increased Risk of C. diff!

Reviewed by: Cynthia T. Nguyen, PharmD, University of Chicago Medicine

Webb and colleagues performed a multicenter, retrospective cohort study among 2356 inpatient cases of symptomatic hospital-onset and healthcare-associated C. difficile infection (CDI) to determine antibiotic-related risk factors. 

After adjusting for demographic and other CDI risk factors, any antibiotic administered prior to the index admission (within 60 days) was the predominant risk factor for CDI, contributing even more risk than receiving antibiotics during the index hospital stay. Notably, antibiotics received prior to the index admission may have included antibiotics received in a different inpatient admission. 

For every day of antibiotic therapy received prior to the index admission, the odds of CDI increased by 12.8% (OR 1.128, CI 1.122-1.134, p<0.0001). Increased CDI risk was observed with prior exposure to all antibiotics, except for daptomycin and doxycycline. Odds of CDI were greatest with 2nd and 3rd generation cephalosporins (oral and IV), as well as anti-pseudomonal carbapenems and fluoroquinolones. 

Antibiotic administration data were limited to outpatient prescriptions documented in the electronic medical record in network hospitals and infusion centers. Therefore, paper prescriptions utilized in the ambulatory settings were not included. Still, this large cohort confirms the relationship between prior antibiotic use and CDI risk, and identifies 2nd and 3rd generation cephalosporins as having the highest risk.


Webb BJ, Subramanian A, Lopansri B, et al. Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection. Antimicrob Agents Chemother. 2020 Jan 21. pii: AAC.02169-19. 

We use cookies to help improve your experience