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Overall antibiotic use linked to C. difficile in U.S. hospitals

Sophia Kazakova, MD, MPH, PhD
Sophia Kazakova

SAN DIEGO — A CDC study of more than 500 U.S. hospitals showed overall inpatient antibiotic use correlated with increased rates of hospital-onset Clostridium difficile infection, or HO-CDI.

These findings, presented at IDWeek, “suggest that reducing overall antibiotic use is an effective strategy for reducing the burden of HO-CDI, particularly when these reductions include broad-spectrum antibiotics, such as fluoroquinolones, cephalosporins and carbapenems,” Sophia Kazakova, MD, MPH, PhD, of the CDC’s Division of Healthcare Quality Promotion, told Healio Gastroenterology and Liver Disease.

This contrasts with recent observations in the U.K., where fluoroquinolones appeared to be the primary driver of the CDI epidemic, and their restriction led to significant reductions in CDI.

“CDI has become the single most common pathogen to cause healthcare-associated infection in the U.S. and is associated with approximately 500,000 new cases and 30,000 deaths annually,” Kazakova said. “Unlike the experience in the U.K., the rates of HO-CDI in the U.S. have not substantially decreased.”

To evaluate the associations and trends in the use of selected antibiotic classes and HO-CDI rates, Kazakova and colleagues analyzed data from 2006 through 2012 on 552 acute care hospitals within the Truven Health MarketScan Hospital Drug Database. During this period, the mean HO-CDI rate was 11 per 10,000 patient days (interquartile range = 5.7-14.7) and mean antibiotic use was 811 days of therapy per 1,000 patient days (IQR = 710-932).

“Our analysis showed that after adjusting for hospital and patient characteristics, hospital-level use of 3rd/4th generation cephalosporins, carbapenems, or overall antibiotic use was significantly associated with HO-CDI rates,” Kazakova said.

For every additional 50 days of antibiotic use per 1,000 patient days, the HO-CDI rate increased by 4.4%. The only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P < .0001) – which increased the HO-CDI rate by 2.1% with every additional 10 days of therapy per 1,000 patient-days – and carbapenems (P = .0011), which increased the HO-CDI rate by 2.4% with every additional 10 days of therapy per 1,000 patient-days. In contrast, fluoroquinolones and beta-lactam/beta-lactamase inhibitor combinations were not significantly associated with HO-CDI.

“While the use of fluoroquinolone decreased significantly between 2006 and 2012, the use of other high-risk antibiotics, such as 3rd/4th gen cephalosporins and carbapenems, increased,” Kazakova noted. “In addition, we found that hospitals that decreased the use of 3rd/4th generation cephalosporins, fluoroquinolones, or overall antibiotic use by 30% or greater, had also achieved a significant reduction in HO-CDI.” – by Adam Leitenberger

Reference:

Kazakova S, et al. Abstract 76. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.

Disclosures: The researchers report no relevant financial disclosures.

Sophia Kazakova, MD, MPH, PhD
Sophia Kazakova

SAN DIEGO — A CDC study of more than 500 U.S. hospitals showed overall inpatient antibiotic use correlated with increased rates of hospital-onset Clostridium difficile infection, or HO-CDI.

These findings, presented at IDWeek, “suggest that reducing overall antibiotic use is an effective strategy for reducing the burden of HO-CDI, particularly when these reductions include broad-spectrum antibiotics, such as fluoroquinolones, cephalosporins and carbapenems,” Sophia Kazakova, MD, MPH, PhD, of the CDC’s Division of Healthcare Quality Promotion, told Healio Gastroenterology and Liver Disease.

This contrasts with recent observations in the U.K., where fluoroquinolones appeared to be the primary driver of the CDI epidemic, and their restriction led to significant reductions in CDI.

“CDI has become the single most common pathogen to cause healthcare-associated infection in the U.S. and is associated with approximately 500,000 new cases and 30,000 deaths annually,” Kazakova said. “Unlike the experience in the U.K., the rates of HO-CDI in the U.S. have not substantially decreased.”

To evaluate the associations and trends in the use of selected antibiotic classes and HO-CDI rates, Kazakova and colleagues analyzed data from 2006 through 2012 on 552 acute care hospitals within the Truven Health MarketScan Hospital Drug Database. During this period, the mean HO-CDI rate was 11 per 10,000 patient days (interquartile range = 5.7-14.7) and mean antibiotic use was 811 days of therapy per 1,000 patient days (IQR = 710-932).

“Our analysis showed that after adjusting for hospital and patient characteristics, hospital-level use of 3rd/4th generation cephalosporins, carbapenems, or overall antibiotic use was significantly associated with HO-CDI rates,” Kazakova said.

For every additional 50 days of antibiotic use per 1,000 patient days, the HO-CDI rate increased by 4.4%. The only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P < .0001) – which increased the HO-CDI rate by 2.1% with every additional 10 days of therapy per 1,000 patient-days – and carbapenems (P = .0011), which increased the HO-CDI rate by 2.4% with every additional 10 days of therapy per 1,000 patient-days. In contrast, fluoroquinolones and beta-lactam/beta-lactamase inhibitor combinations were not significantly associated with HO-CDI.

“While the use of fluoroquinolone decreased significantly between 2006 and 2012, the use of other high-risk antibiotics, such as 3rd/4th gen cephalosporins and carbapenems, increased,” Kazakova noted. “In addition, we found that hospitals that decreased the use of 3rd/4th generation cephalosporins, fluoroquinolones, or overall antibiotic use by 30% or greater, had also achieved a significant reduction in HO-CDI.” – by Adam Leitenberger

Reference:

Kazakova S, et al. Abstract 76. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.

Disclosures: The researchers report no relevant financial disclosures.

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