Antibiotic use and risk factors linked to AAD and CDAD in critically ill patients
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Key Takeaway
Note that antibiotic use and risk factors are associated with AAD and CDAD in critically ill patients.
This systematic review and meta-analysis examined the incidence of antibiotic-associated diarrhea (AAD) and Clostridioides difficile-associated diarrhea (CDAD) within populations of critically ill patients. The investigation synthesized data from multiple studies to assess the impact of antibiotic use and associated risk factors on gastrointestinal outcomes in this vulnerable group.
The analysis covered a broad spectrum of medications, including cephalosporins, glycopeptide antibiotics, antifungal agents, beta-lactam plus enzyme inhibitor combinations, proton pump inhibitors, probiotics, and carbapenem antibiotics. The primary outcome measured was the incidence rates of AAD and CDAD across these diverse therapeutic exposures and risk profiles.
Exact numerical results regarding incidence rates or specific risk ratios were not reported in the provided evidence. Consequently, precise quantitative comparisons between the different medication classes or risk factors could not be detailed. Safety and tolerability data were also not reported in the available input.
Key limitations include the observational design of the underlying studies, which precludes definitive causal conclusions about specific drug effects. The lack of reported sample sizes and specific numerical outcomes restricts the ability to determine the magnitude of risk associated with individual interventions. These findings suggest that clinicians should remain cautious when interpreting associations between antibiotic use and diarrhea in critically ill settings.
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View Original Abstract ↓
BACKGROUND/AIMS: This meta-analysis aims to quantitatively assess the incidence and risk factors of both antibiotic-associated diarrhea (AAD) and Clostridioides difficile-associated diarrhea (CDAD) in critically ill patients.
METHODS: We searched Cochrane Library, Web of Science, Embase, PubMed, CNKI, and Wanfang until February 2025. Studies were screened, extracted, and assessed using the Newcastle-Ottawa Scale and GRADE. Analyses used RevMan 5.4 and Stata 15.
RESULTS: This meta-analysis revealed an overall incidence of AAD of 29% (95% CI = 24%-35%) in critically ill patients. The following 16 independent risk factors were identified: age (MD = 4.81, 95% CI = 2.85-6.78), male (OR = 1.23, 95% CI = 1.04-1.45),hypertension (OR = 1.86, 95% CI = 1.51-2.29), diabetes (OR = 1.42, 95% CI = 1.11-1.82), cephalosporin (OR = 1.67, 95% CI = 1.31-2.12), glycopeptide antibiotic (OR = 1.48, 95% CI = 1.10-1.98), antifungal agent (OR = 2.55, 95% CI = 1.90-3.41), β-lactam plus enzyme inhibitor (OR = 2.38, 95% CI = 1.86-3.06), proton pump inhibitor (OR = 0.56, 95% CI = 0.37-0.85), probiotic (OR = 1.69, 95% CI = 1.20-2.36), combined antibiotic use (OR = 2.44, 95% CI = 1.96-3.04), gastrointestinal surgery (OR = 2.00, 95% CI = 1.20-3.34), parenteral nutrition (OR = 1.60, 95% CI = 1.18-2.16), duration of antibiotic use (MD = 4.15, 95% CI = 2.93-5.37), APACHE II score (MD = 1.10, 95% CI = 0.55-1.65), and length of ICU stay (MD = 7.02, 95% CI = 4.39-9.66). Additionally, the incidence of CDAD was 12% (95% CI = 7%-17%), with risk factors including enteral nutrition (OR = 2.11, 95% CI = 1.37-3.24), mechanical ventilation (OR = 1.61, 95% CI = 1.12-2.33), carbapenem antibiotic (OR = 1.71, 95% CI = 1.07-2.75), kidney disease (OR = 1.74, 95% CI = 1.04-2.90),and diabetes (OR = 1.83, 95% CI = 1.05-3.21).
CONCLUSIONS: These findings help identify high-risk patients and guide AAD and CDAD prevention in critical care.
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