Clinical Edge

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

De-escalation of Antimicrobial Therapy on CDI Risk

Clin Infect Dis; ePub 2018 Oct 12; Seddon, et al

Among patients with Enterobacteriaceae bloodstream infections (BSI), the empirical use of antipseudomonal beta-lactams (APBL) for >48 hours was an independent risk factor for Clostridioides difficile infection (CDI), a new study found. Adult patients hospitalized for >48 hours for treatment of Enterobacteriaceae BSI at Palmetto Health hospitals in Columbia, SC from January 1, 2011, through June 30, 2015, were included. Multivariable Cox proportional hazards regression was used to examined time to CDI in patients who received >48 hour and ≤48 hour of APBL for empirical therapy of Enterobacteriaceae BSI after adjustment for the propensity to receive >48 hours of APBL. Researchers found:

  • Among 8,089 patients with Enterobacteriaceae BSI, 414 and 394 received >48 hours and ≤48 hours of APBL, respectively.
  • Incidence of CDI was higher in patients who received >48 hours of APBL.
  • After adjustment for propensity to receive >48 hours of APBL and other variables, receipt of >48 hours of APBL (HR, 3.38) and end-stage renal disease (HR, 4.04) were independently associated with higher risk of CDI.


Seddon MM, Bookstaver PB, Justo JA, et al. Role of early de-escalation of antimicrobial therapy on risk of Clostridioides difficile infection following Enterobacteriaceae bloodstream infections. [Published online ahead of print October 12, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy863.