Widespread antibiotic use linked to higher risk of hospital associated C. difficile infections

USA: Rates of resistance to antimicrobial agents continue to increase at hospitals. Improving the use of antimicrobials can help to combat the spread of antibiotic resistance. Now, a recent study has highlighted the importance of tracking trends of antimicrobial use over time as it also relates to clostridium difficile infection (CDI).

According to the study, published in the Infection Control & Hospital Epidemiology, high-risk antibiotic use is linked to increases in hospital-associated CDI (HA CDI). Every 100-day increase in the use of four antibiotic classes that are deemed high risk -- cephalosporins, fluoroquinolones, carbapenems, and lincosamides -- the risk of HA CDI increased to 12%.

Antibiotic resistance is one of the most important global health issues of our times. Global cooperation to tackle antimicrobial resistance is essential and is a key area where global cooperation is needed. An estimated 7,00,000 people die each year globally due to drug-resistant diseases.

While C. difficile is not an antibiotic-resistant organism in the sense of it developing important resistance to the drugs used to treat CDI, it is intrinsically resistant to many antibiotics and commonly acquires new resistance to antibiotics used to treat other common infections, note the authors.

Clostridium difficile is a gram-positive bacterium that is a major cause of nosocomial diarrhoea worldwide. Symptoms of C. difficile infection (CDI) range from mild diarrhoea to severe outcomes, including pseudomembranous colitis, toxic megacolon, intestinal perforation, and even death.

Ying P. Tabak, Becton, Dickinson and Co., Franklin Lakes, New Jersey, and colleagues evaluated previously defined high-risk antibiotic use in relation to CDIs. For which, they looked at microbiologic and pharmacy data from 171 US community and teaching hospitals from June 2016 through July 2017. The data focused on the combined use of the four high-risk antibiotics, with additional evaluation of the four classes individually.

Hospital-level use was measured as days of therapy (DOT) per 1,000 days present (DP).

The multivariable analysis estimated the relative risk (RR) of these antibiotics on HA CDI while controlling for other risk factors, such as community CDI pressure, length of hospital stay, the proportion of elderly patients, and hospital characteristics.

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Key findings include:

• The median days of therapy for high-risk antibiotic use was 241.2 per 1,000 days present; the overall HA CDI rate was 33 per 10,000 admissions.


• The overall correlation of high-risk antibiotic use and HA CDI was 0.22, and higher correlation was observed in teaching hospitals.


• For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI after adjusting for confounders.

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They conclude, "Future studies would ideally combine both facility- and patient-level measures of high-risk and total antibiotic use to further inform CDI mitigation strategies."

"It will be important to look at the effect of antibiotic use on C. difficile infection and antibiotic resistance together versus separately," they wrote.

To read the complete study log on to https://doi.org/10.1017/ice.2019.236