Analyses of fluoroquinolones and Clostridium difficile-associated diarrhoea in tuberculosis patients

Int J Tuberc Lung Dis. 2009 Mar;13(3):341-6.

Abstract

Setting: Systematic studies of fluoroquinolones (FQs) and Clostridium difficile-associated diarrhoea (CDAD) are scarce among tuberculosis (TB) patients, in whom fluoroquinolones (FQs) are increasingly used.

Objective: To evaluate the relationship between FQs and CDAD among TB patients.

Design: Retrospective cohort and nested case-control analyses were conducted among 3319 hospital patients on anti-tuberculosis treatment from 1999 to 2005. Each case of CDAD was matched by three sex- and age-matched controls randomly selected from the rest of the cohort. Not every case was confirmed by C. difficile cytotoxins.

Results: Among 38 cases studied, the incidence of CDAD, which was 28.2 (95%CI 20.3-38.3) per 100 000 patient-days overall, increased from 12.9 (95%CI 5.8-25.3) for patients aged <60 years to 26.6 (95%CI 15.5-42.8) for those aged between 60 and 79 years, and 66.9 (95%CI 39.8-106.1) for those aged >79 years. Univariate analysis showed a significant association between CDAD and age, FQs, non-FQ antibiotics, serum albumin level, duration of hospital stay and nasogastric feeding. Only duration of hospital stay and nasogastric feeding remained significant on multivariable analysis.

Conclusion: The risk of CDAD due to FQs among TB patients is probably modest after controlling for sex, age, non-FQ antibiotics, serum albumin level, duration of hospital stay and nasogastric feeding.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / therapeutic use
  • Case-Control Studies
  • Clostridium Infections / epidemiology
  • Clostridium Infections / etiology*
  • Comorbidity
  • Diarrhea / microbiology*
  • Enteral Nutrition
  • Female
  • Fluoroquinolones / adverse effects*
  • Fluoroquinolones / therapeutic use
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology

Substances

  • Anti-Bacterial Agents
  • Fluoroquinolones