Clostridioides difficile infection risk and contemporary antibiotic use: Evidence from a large real-world dataset highlighting the need for a comprehensive antibiotic stewardship in dentistry

Document Type

Article

Publication Title

Journal of Dental Sciences

Abstract

Background/purpose: In dental care, antibiotics are frequently used for infection control. While certain antibiotics are historically linked to the increased risk of Clostridioides difficile infection (CDI). Existing risk classifications may not reflect current prescribing practices or patient outcomes. This study seeks to investigate antibiotic exposure patterns in patients prior to CDI symptom emergence and diagnosis to better understand true risk associations. Materials and methods: We performed a retrospective cohort analysis using the TriNetX healthcare database to examine prior antibiotic exposure in patients diagnosed with CDI. The study focused on adults with confirmed CDI cases. To isolate a distinct patient group, individuals who had received standard CDI treatments vancomycin, metronidazole, or fidaxomicin either before or after diagnosis were excluded. This approach aimed to assess antibiotic exposure without the influence of common CDI therapies. Results: Out of 201,911 CDI patients analyzed, 33.9 % (68,535) had been exposed to antibiotics. Focusing on antibiotic use within the two weeks leading up to diagnosis. We identified distinct antibiotic classes, with the most used being extended-spectrum penicillin (18.6 %), third-generation cephalosporins (15.8 %), and amino penicillins (15.3 %). Conclusion: This study sheds light on real-world antibiotic prescribing patterns among a broad clinical population. Notably, historically high-risk antibiotics like clindamycin and fluoroquinolones were not the most frequently used prior to CDI diagnosis. These insights underscore the importance of comprehensive antibiotic stewardship across all classes prescribed in dental care.

DOI

10.1016/j.jds.2025.08.020

Publication Date

1-1-2025

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