The spores of Clostridium difficile are very difficult to eradicate and known to contaminate hospital room surfaces such as beds, rails, floors and walls, resulting in exposure to incoming patients. A large retrospective study of hospitalised patients conducted by Freedberg et al. (2016), examined whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for C. difficile infection (CDI) in subsequent patients who occupy the same bed. Antibiotics are the crucial risk factor for CDI, but it is unknown how one hospitalised patient’s receipt of antibiotics may affect risk for CDI for a different patient within the same environment. After adjusting for factors that are known to cause CDI, and removing cases in which the initial patient had CDI, the study found that the risk of CDI increased by 22% for a patient whose hospital bed had been previously occupied by someone who was receiving antibiotics. Aside from antibiotics, no other factors related to the prior bed occupants were associated with increased risk for CDI in subsequent patients.
The study implies that antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk for CDI and gives a direct example of the harm imposed by antibiotics on patients who do not themselves receive antibiotics.
Freedberg DE, Salmasian H, Cohen B, Abrams JA, Larson EL. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med 2016;176(12):1801-1808. doi:10.1001/jamainternmed.2016.6193
Link to the abstract of the article: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2565687
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