<p>Combined administration of antibiotics increases the incidence of antibiotic-associated diarrhea in critically ill patients</p>

Abstract

Background: The widespread use of antibiotics has resulted in a high incidence of antibiotic-associated diarrhea (AAD); moreover, the AAD-associated mortality rates have also increased. The effect of combined antibiotic administration on AAD in critically ill patients was analyzed to assist in antibiotic selection for AAD prevention. Methods: Clinical data of patients hospitalized were retrospectively analyzed. Patients were either assigned to the combined-use group (CG) or the monotherapy group (MG). Age, sex, albumin levels, proton pump inhibitors, the type antibiotics, occurrence of AAD were collected. All relevant data were analyzed using SPSS version 18.0 (IBM Inc., Armonk, NY, USA), and significance was set at P <0.05. Measurements and main results: Overall, 277 patients were enrolled (CG, n=143; MG, n=134). The incidence of AAD was significantly different between the groups (44.06% vs 17.16%, P <0.001). Combined use of three or more antibiotics, other antibiotics combined with antifungals antibiotics increases the incidence of AAD ( P <0.05). Duration of proton pump inhibitor therapy (odds ratio [OR] 1.142, 95% confidence interval [CI] 1.048–1.244, P =0.002), antifungal antibiotic administration (OR 3.189, 95% CI 1.314–7.740, P =0.010), and beta-lactam plus enzyme inhibitor antibiotic administration (OR 3.072, 95% CI 1.309–7.205, P =0.010) were associated with AAD in critically ill patients receiving combined antibiotics therapy. The mean duration of intensive care unit admission was longer among patients with AAD compared with patients without AAD (19.70±12.16 vs 12.29±8.06 days, P <0.001), with no significant difference in intensive care unit-related mortality rates. Conclusion: Combined administration of antibiotics, especially beta-lactam plus enzyme inhibitors and antifungals, may increase the incidence of AAD in critically ill patients.

Evaluation of anti-infective-related Clostridium difficile-associated colitis using the Japanese Adverse Drug Event Report database

“…It is reported that the incidence rates of CDI following 1-3, 4-6, and 7-11 days of cephalosporin exposure were 1.60, 2.27, and 2.10 times higher than those in no prior receipt, respectively [38]. Other risk factors for CDI include the use of a co-administered proton pomp inhibitor and the length of hospital stay [18,24]. In this study, we did not evaluate the effect of these factors.…”

“…Contrarily, in a retrospective cohort study, compared with that for patients who received only 1 antibiotic, the adjusted hazard ratios (HRs) of CDI for those who received 2, 3 or 4, or 5 or more antibiotics were 2.5 (95% CI 1.6-4.0), 3.3 (95% CI 2.2-5.2), and 9.6 (95% CI 6.1-15.1), respectively [39]. Anti-infective-related diarrhea has been reported to be at higher risk in combination therapy than in monotherapy [24]. Therefore, we evaluated the risk of CDAC in the real-world clinical setting.…”

“…The number of administered anti-infectives can lead to drug interactions and may be an important risk factor for CDAC. It has been reported that antibiotic-associated diarrhea incidence was significantly higher in the combined drug-use group than in the monotherapy group [24]. To the best of our knowledge, the association between the number of concomitantly used antibiotics and CDAC remains unclear.…”

Recombinant human thrombopoietin in critically ill patients with sepsis-associated thrombocytopenia: A clinical study

“…; as such, these patients cannot be included in the statistics of ICU mortality. However, some of these patients died after leaving the hospital and excluding this may be the main reason for the difference in 28day mortality (Ma et al, 2019). The difference could also be related to the small sample size and the retrospective nature of this study from a single centre.…”

Features of intestinal damage in COVID-19

“…Существуют данные о том, что длительность применения ингибиторов протонной помпы была связана с ААД у пациентов, получавших монотерапию антибиотиками [62,63]. К числу других факторов риска ААД относят также хиругические вмешательства на органах брюшной полости и применение глюкокортикоидов.…”