Choosing Wisely:

Don’t use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence.

Rationale and Comments: C. difficile can be a life-threatening illness and is generally caused by antibiotics killing normal bacteria in the intestine. Patients recovering from C. difficile are three times as likely to have a recurrence if they receive an antibiotic in the following month. However, unnecessary antibiotics are often used in this population – primarily for misdiagnosed urinary tract infection or pneumonia.
Sponsoring Organizations:
  • Society for Healthcare Epidemiology of America
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gastroenterologic
  • Infectious disease
  • References: • Shaughnessy MK, Amundson WH, Kuskowski MA, DeCarolis DD, Johnson JR, Drekonja DM. Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection. Infect Control Hosp Epidemiol. 2013 Feb;34(2):109-16.
    • Drekonja DM, Amundson WH, Decarolis DD, Kuskowski MA, Lederle FA, Johnson JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med. 2011 Nov;124(11):1081.e1-7.
    • Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S48-65.

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