Clindamycin, Gentamicin, and Risk of Clostridium difficile Infection and Acute Kidney Injury During Delivery Hospitalizations :

Abstract

To describe risk of Clostridium difficile infection associated with clindamycin and acute kidney injury associated with gentamicin during delivery hospitalizations. Women admitted for delivery from January 2006 to March 2015 were analyzed using an inpatient administrative database. Primary outcomes were C. difficile infection and acute kidney injury. Clostridium difficile infection was compared between women receiving clindamycin (with or without other antibiotics) and women receiving antibiotics other than clindamycin. Acute kidney injury was compared between women receiving gentamicin (with or without other antibiotics), women receiving antibiotics other than gentamicin, and women receiving no antibiotics. Unadjusted and adjusted log linear models analyzing the role of patient demographics, mode of delivery, and hospital-level characteristics were created evaluating risk for C. difficile infection and acute kidney injury with risk ratios (RR) and adjusted risk ratios with 95% confidence intervals (CI) as measures of association. A sensitivity analysis for gentamicin and acute kidney injury was performed restricted to women with preeclampsia. Of 5,657,523 women admitted for delivery hospitalization, 266,402 (4.7%) received clindamycin and 165,726 (2.9%) received gentamicin. Clostridium difficile infection was diagnosed in 0.04% of women receiving clindamycin. Compared to women receiving other antibiotics, clindamycin was associated with a nearly three-fold increased risk of C. difficile infection (RR 2.93, 95% CI 2.36, 3.65). Acute kidney injury was diagnosed in 0.24% of women receiving gentamicin. Gentamicin was associated with a three-fold risk of acute kidney injury (RR 3.01, 95% CI 2.71, 3.34) compared to women receiving other antibiotics, while receipt of no antibiotics was associated with significantly lower risk (RR 0.18, 95% CI 0.15, 0.20). In adjusted analyses, these associations retained significance. Significantly increased risk for acute kidney injury was noted with women with preeclampsia receiving gentamicin (RR 2.04, 95% CI 1.64, 2.53). Receipt of clindamycin was associated with significantly increased likelihood for C. difficile infection and receipt of gentamicin with significantly increased likelihood of acute kidney injury, although the absolute risk for these complications was low. Clindamycin and gentamicin were associated, respectively, with significantly increased relative risk, but low absolute risk of Clostridium difficile infection and nephrotoxicity during delivery hospitalizations.