Associations of facility-level antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2012-2018.

Sophia V Kazakova,Sujan C Reddy,Kelly M Hatfield,Alice Y Guh,L Clifford Mcdonald,Sarah H Yi,John A Jernigan,James Baggs

doi:10.1017/ice.2021.151

Abstract

Previously reported associations between hospital-level antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) were reexamined using 2012-2018 data from a new cohort of US acute-care hospitals. This analysis revealed significant positive associations between total, third-generation, and fourth-generation cephalosporin, fluoroquinolone, carbapenem, and piperacillin-tazobactam use and HO-CDI rates, confirming previous findings.

Highlights

The number of cases of Clostridioides difficile infection (CDI) in the United States has decreased in recent years,[1,2] disease burden remains high,[3] and the Centers for Disease Control and Prevention has recently declared CDI an urgent public health threat.[4]
Decreases in total antibiotic use, fluoroquinolones, carbapenems, and combined use of fluoroquinolones, third- and fourth-generation cephalosporins, and carbapenems corresponded with decreases in hospital-onset CDI (HO-CDI)
nucleic acid amplification test (NAAT) utilization was derived from administrative data, which is subject to several previously described limitations,[7] its temporal association with HO-CDI indicates the importance of including this factor in HO-CDI models (Supplementary Fig. 2 online)

Summary

Introduction

The number of cases of Clostridioides difficile infection (CDI) in the United States has decreased in recent years,[1,2] disease burden remains high,[3] and the Centers for Disease Control and Prevention has recently declared CDI an urgent public health threat.[4] Decreases in hospital-onset CDI (HO-CDI) rates have occurred despite relatively stable national rates of overall inpatient antibiotic use.[5,6] Previously, we reported the association between hospital-level antibiotic use rates and HO-CDI rates in acute-care hospitals (ACHs) from 2006 to 2012.7 In this analysis, we reexamined the cross-sectional and temporal associations between hospital-level antibiotic use and HO-CDI rates using more recent data from a separate cohort of ACHs

Methods

Results

Conclusion