Study: Ceftriaxone for Pneumonia Elevates C. difficile Risks, "Should Be Shunned"

DECEMBER 01, 2016
Rachel Lutz
infectious disease, gastroenterology, c. difficile infection, clostridium difficile infection, cdi, hospital medicine, pimary care, pneumonia, antibiotics, antibiotic resistanceA new study suggests that there are two mortality models for patients with pneumonia who are being treated for Clostridium difficile (C. difficile) infection. Additionally, the same research team found an antibiotic that they believe should be excluded from pneumonia treatment in hospitals.
 
Researchers from the Medical University in Warsaw in Poland retrospectively analyzed pneumonia patients in order to examine the mortality risk in the patients who were also treated for C. difficile infection. The study authors stated that one of the most common infections after antibiotic treatment for pneumonia is caused by C. difficile spores.

The researchers identified 94 cases of post-pneumonia C. difficile infection patients from the 217 C. difficile infected patients in the cohort. Then, the investigators analyzed mortality while considering various risk factors including patient demographics, features of the clinic or hospital, and the laboratory results. The researchers additionally included the severity of the pneumonia cases in order to allow for estimates of respiratory influence on the course of disease. 
 
The findings presented two statistically significant and clinically relevant mortality models, the study authors reported. 
 
"The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease," the scientists wrote. 
 
The researchers believe that these two prognostic models can help predict mortality risk in C. difficile infection, in addition and secondary to the antibiotic treatment of pneumonia. The investigators also believe these models could be helpful in creating individualized therapies for specific patients.  
 
The study, entitled “Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models”, was published this month in the journal Advances in Experimental Medicine and Biology.
 
In an earlier examination from September 2016, the research team aimed to quantify the antibiotic treatment of hospitalized pneumonia patients who contracted a C. difficile infection. Of 217 patients whose records were retrospectively analyzed, 94 met infection criteria after pneumonia treatment. About half, 50 patients, were classified as having severe or severe and complicated C. difficile infection. 
 
The patients with pneumonia who later contracted C. difficile were treated with: ceftriaxone in 14 (28%) cases, amoxicillin with clavulanate in nine (18%), ciprofloxacin in eight (16%), clarithromycin in seven (14%), and cefuroxime and imipenem in six (12%) each.

“The findings revealed a borderline enhancement in the proportion of deaths due to C. difficile infection in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups,” the researchers concluded in that Advancements in Clinical Research study. “The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post pneumonia mortality in patients who developed C. difficile infection.”
 
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