The included studies used a variety of terminology to describe the clinical presence of C. difficile in patients, such as C. difficile infection, C. difficile-associated diarrhea, C. difficile-associated disease, and C. difficile-enteric disease. [...] The effect estimates for each of the variables in their analysis are shown in Table 1. Based on an examination of funnel plots, the authors reported that there is potential publication bias in the Evidence-Based Risk Factors for Contracting C. difficile. [...] There is a lack of agreement amongst these studies with regard to the association between the use of agents for gastric acid suppression and the development of C. difficile infection. [...] Two studies36,39 reported a significant association with use of PPIs and two other studies reported that there was no significant association between use of these agents and the risk of C. difficile infection.5,38 With regard to the antimicrobial agents as risk factors for C. difficile infection, findings are also relatively consistent with those reported in the case-control studies. [...] Results of the time-series analysis demonstrated that temporal variations in the usage of third- generation cephalosporins, fluoroquinolones, and macrolides were followed by changes in the incidence of C. difficile infections in the same direction (i.e., increased use of these antimicrobials was associated with more C. difficile infections).
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