IN FECTIO N PRE VE NTIO N
Antibiotic Use Highly Tied to C. diff in Hospitals BY ETHAN COVEY
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ntibiotic use is significantly associated with hospital-onset Clostridioides difficile infection (HO-CDI), according to data taken from a large cohort of U.S.-based acute care hospitals (ACHs). The findings build upon previous research that reported on antibiotic usage and HO-CDI rates from 2006 to 2012 (Infect Control Hosp Epidemiol 2021 May 7. doi:10.1017/ ice.2021.151; bit.ly/3ojGVfc-IDSE). “This study is important because it confirms and extends previous research on the association of broad-spectrum antibiotics and CDI,” said Sophia Kazakova, MD, PhD, a health scientist with the CDC’s Division of Healthcare Quality Promotion. “These findings should encourage clinicians, infection control and antibiotic stewardship programs to strengthen antibiotic use monitoring and continue to focus on reducing use across all classes of antibiotics to reduce CDI.” The researchers reviewed data on adult discharge and inpatient charge records for antibiotic use, CDI testing and CDI treatment for 921 ACHs from Jan. 1, 2012, to Dec. 31, 2018, HO-CDI rates were calculated and compared with days of therapy (DOT) for seven antibiotic classes. The results showed a clear association between higher levels of antibiotic use and rates of HO-CDI. For every 50 DOT per 1,000 patient days increase in antibiotic use, HO-CDI rates increased by 2.8%. When looking at specific classes of antibiotics, 10 DOT per 1,000 patient days increases in the use of carbapenems, cephalosporins and piperacillin-tazobactam were associated with 1.3%, 0.6%, and 1.1% increases in the rate of HO-CDI, respectively. New to this batch of data was information regarding the use of 12
OR Management News • Volume 16 • December 2021
nucleic acid amplification testing (NAAT) for diagnosis. Upon examining temporal trends in hospital use of NAAT testing, the authors found that hospitals using only NAAT diagnostic tests for CDI had a 16% higher HO-CDI rate. “Even when controlling for NAAT use and other known patient and hospital confounders, we found strong positive cross-sectional and temporal associations between CDI and total and class-specific antibiotic use,” Dr. Kazakova noted. “This indicates that future studies should include this factor in CDI models.” Among the four hospitals that decreased total antibiotic use during the study period by 30% or more, HO-CDI rates decreased by 40%. Decreases in fluoroquinolone and carbapenem use corresponded with annual decreases in HO-CDI rates of 4% to 7% and 4% to 8%, and decreases in cephalosporins, fluoroquinolones, and carbapenems corresponded with annual decreases in the HO-CDI rate of 4% to 16%. Mohamed H Yassin, MD, PhD, an associate professor of medicine, University of Pittsburgh School of Medicine, told OR Management News that the paper showed that hospitals need to focus efforts on traditional infection prevention efforts as well as antibiotic stewardship programs to reduce unnecessary antibiotic use. “This paper sends a clear message to hospitals to increase their efforts further to reduce antibiotic use,” he said. Dr. Kazakova added that additional study may help clarify appropriate antibiotic usage. “Since higher antibiotic use is associated with higher rates of CDI, more research into defining and quantifying inappropriate and unnecessary use would be ■ valuable,” she said.
