Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Antimicrobial Prescribing After CDI Diagnosis

Am J Infect Contr; ePub 2018 May 17; Watson, et al

Inappropriate antimicrobial use after initial Clostridium difficile infection (iCDI) diagnosis was associated with higher risk of recurrent CDI, a recent study found. Researchers reviewed medication administration records for all patients from the Greater Los Angeles Veterans Administration with new CDI from 2015-2016 to determine appropriateness of all non-CDI antimicrobials prescribed within 90 days pre- and post-initial CDI positive testing. They found:

  • 210 patients were diagnosed with new-onset iCDI, 140 met inclusion criteria.
  • Of antimicrobial courses prescribed, 40.6% or pre-iCDI were inappropriate compared with 43.1% of post-iCDI.
  • 33 patients developed recurrent CDI.
  • After adjustment for risk factors, inappropriate antimicrobial use was associated with a significant increased risk of recurrence compared with appropriate use alone (OR, 6.19).
  • Antimicrobial use in general was associated with increased recurrence vs no antimicrobial use post-iCDI (OR, 2.6).


Watson RL, Graber CJ. Lack of improvement in antimicrobial prescribing after a diagnosis of Clostridium difficile and impact on recurrence. [Published online ahead of print May 17, 2018]. Am J Infect Contr. doi:10.1016/j.ajic.2018.04.213.

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