DENVER – Use of systemic corticosteroids during antibiotic treatment for respiratory infections may reduce the incidence of Clostridium difficile–associated diarrhea, a single-center study demonstrated.
"Using steroids may not predispose people to having C diff, as previously thought," Amy Wojciechowski, Pharm.D., said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. "Don’t be afraid to use steroids when you’re treating with antibiotics. You’re not going to increase your risk of C. diff. You may even be decreasing it."
Dr. Amy Wojciechowski
Dr. Wojciechowski, along with Kari Mergenhagen, Pharm.D., and their associates at the VA Western New York Healthcare System, Buffalo, set out to determine the incidence of Clostridium difficile–associated diarrhea (CDAD) in patients treated in the hospital with antibiotics for a chronic obstructive pulmonary disease (COPD) exacerbation or community-acquired pneumonia (CAP). The investigators evaluated baseline characteristics and risk factors that affect the incidence of CDAD.
The study population comprised 532 veterans who were hospitalized between March 2006 and July 2012 and were treated with moxifloxacin or with ceftriaxone plus azithromycin. CDAD was defined as diarrhea with positive PCR assay or toxin assay for C difficile within 30 days of antibiotic treatment.
The mean age of the veterans was 76 years, and 99% were male. The researchers found that CDAD occurred in 11 patients in the study population, for an incidence rate of 2.07%.
Variables associated with a significantly decreased risk of CDAD were diagnosis of COPD (P = .01) and use of corticosteroids during antibiotics treatment (P = .0035). There was no difference in the incidence of CDAD between patients treated with moxifloxacin and those treated with ceftriaxone plus azithromycin.
After the researchers controlled for COPD, the use of corticosteroids remained linked to a decreased risk of developing CDAD (odds ratio, 0.12).
The researchers hypothesized that steroids "may attenuate the host immune response typically seen in response to C difficile toxins, thus preventing inflammation and cytokine release associated with the symptoms of CDAD." They added that more research is needed to determine whether the findings are the same in other patient populations.
The authors acknowledged as limitations of the study its retrospective design and the fact that the majority of patients where white men.
Dr. Wojciechowski, an infectious diseases pharmacy resident, and Dr. Mergenhagen, a clinical infectious diseases pharmacist, said that they had no relevant conflicts of interest to disclose.