Abstract
BackgroundHealthcare facility-onset Clostridioides difficile infection is the leading cause of antibiotic-associated diarrhea, and is associated with morbidity and mortality. The use of antibiotics is an important risk factor for healthcare facility-onset C. difficile infection. We evaluated the correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption, according to antibiotic class.MethodsPatients with healthcare facility-onset C. difficile infection from January 2017 to December 2018 at Konkuk University Medical Center (a tertiary medical center) were included. We evaluated changes in the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption. The correlation between the incidence of healthcare facility-onset C. difficile infection and antibiotic consumption was evaluated two ways: without a time interval and with 1-month interval matching.ResultsA total of 446 episodes of healthcare facility-onset C. difficile infection occurred during the study period. The incidence of healthcare facility-onset C. difficile infection was 9.3 episodes per 10,000 patient-days, and increased significantly. We observed an increase in the consumption of β-lactam/β-lactamase inhibitors, and a decrease in the consumption of other classes of antibiotics, with a significant decrease in the consumption of fluoroquinolones, glycopeptides, and clindamycin (P = 0.01, P < 0.001, and P = 0.001, respectively). The consumption of β-lactam/β-lactamase inhibitors was independently correlated with the incidence of healthcare facility-onset C. difficile infection in the analysis without a time interval. When the analysis was conducted with 1-month interval matching, glycopeptide consumption was independently associated with the incidence of healthcare facility-onset C. difficile infection.ConclusionsDespite the reduction in fluoroquinolone and clindamycin consumption, the incidence of healthcare facility-onset C. difficile infection increased during the study period, and was correlated with increased consumption of β-lactam/β-lactamase inhibitors. Reduced consumption of specific antibiotics may be insufficient to reduce the incidence of healthcare facility-onset C. difficile infection.
Highlights
Healthcare facility-onset Clostridioides difficile infection is the leading cause of antibiotic-associated diarrhea, and is associated with morbidity and mortality
The incidence of healthcare facility-onset (HO)-Clostridioides difficile infection (CDI) was significantly associated with the consumption of β-Lactam/β-lactamase inhibitors (BLBLIs) and glycopeptide in terms of defined daily dose (DDD), and BLBLIs, third-generation cephalosporins, fourth-generation cephalosporins, and glycopeptides in terms of days of therapy (DOT) (Table 1)
We found that the incidence of Healthcare facilityonset Clostridioides difficile infection (HO-CDI) significantly increased during the study period, despite no increase in the total consumption of antibiotics in terms of DDD and DOT
Summary
Healthcare facility-onset Clostridioides difficile infection is the leading cause of antibiotic-associated diarrhea, and is associated with morbidity and mortality. There have been many attempts to reduce the incidence of healthcare facility-onset (HO)CDI, including antibiotic stewardship programs and infection control measures [8,9,10,11,12,13,14,15]. A reduction in antibiotic consumption, due to antibiotic stewardship programs, resulted in a decrease in the incidence of HO-CDI [8,9,10, 12, 14]. These studies were conducted in Western countries, such as the United States and Europe. Because of the differences in the major strains and their antibiotic susceptibility, the effect of antibiotic stewardship programs on the incidence of HO-CDI may differ depending on the nation [19]
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