{
  "abstract": "Background Clostridioides difficile infections (CDIs) are associated with antibiotic use, although the link with other drugs remains underexplored.Objectives To investigate the association between antibiotic and non-antibiotic drugs with microbiome-modulating activity on new occurrences of CDI.Design We conducted a Swedish population-based case–control study from 2006 to 2019 including 42 921 cases matched with 355 159 population controls on age and sex, obtained from multiple linked Swedish registries. The effect of antibiotic and non-antibiotic use within 30 days from the index date on CDI occurrence was estimated using multivariable conditional logistic regression additionally with a lasso penalty. Models were adjusted for age and sex by design and for Charlson Comorbidity Index and concomitant drug use, providing adjusted ORs (aORs) with 95% CIs.Results Antibiotics with the greatest CDI risk were lincosamides (aOR=31.4, 95% CI 27.9 to 35.3), combinations of penicillins (aOR=19.8, 95% CI 15.9 to 24.5), sulfonamides and trimethoprim, and cephalosporins, though no association for tetracyclines. Among non-antibiotic drugs, we found decreased risks of CDI for lipid-modifiers (aOR=0.8, 95% CI 0.8 to 0.8) and aspirin (aOR=0.8, 95% CI 0.7 to 0.8) and increased risks for antidiarrhoeals (aOR=7.3, 95% CI 6.8 to 7.8), corticosteroids (aOR=2.4, 95% CI 2.3 to 2.5), proton-pump inhibitors (PPIs) (aOR=1.8, 95% CI 1.7 to 1.8), nervous system drugs, constipation drugs, histamine H2-receptor antagonists, antidepressants, and beta blockers, but no significant risk for non-steroidal anti-inflammatory drugs.Conclusions We found varying effects of antibiotics on CDI, providing evidence for ongoing efforts in prudent prescribing decisions and antimicrobial stewardship. We confirmed PPI as a main risk factor for CDI and provided new evidence for other non-antibiotic drugs as potentially important risk factors considering their high prescription prevalence.",
  "authors": [
    {
      "affiliations": [
        "Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden",
        "Global Health Institute, Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium"
      ],
      "name": "Annelies Boven"
    },
    {
      "affiliations": [
        "Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden",
        "Global Health Institute, Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium"
      ],
      "name": "Harry Vranken"
    },
    {
      "affiliations": [
        "Global Health Institute, Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium"
      ],
      "name": "Erika Vlieghe"
    },
    {
      "affiliations": [
        "Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands"
      ],
      "name": "Annemarie Boleij"
    },
    {
      "affiliations": [
        "School of Health and Medical Sciences, Örebro University, Örebro, Sweden"
      ],
      "name": "Katja Fall"
    },
    {
      "affiliations": [
        "Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Lars Engstrand"
    },
    {
      "affiliations": [
        "Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden",
        "Global Health Institute, Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium",
        "Department of Public Health and Primary Care, Ghent University, Ghent, Belgium"
      ],
      "name": "Nele Brusselaers"
    }
  ],
  "title": "Commonly prescribed drugs as risk factors for Clostridioides difficile infections: a Swedish population-based case–control study",
  "uid": "2f72b03a-a9db-5b67-9b23-73f8d38972ad"
}