September 24, 2019
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Use of high-risk antibiotics correlates with more hospital-associated CDI

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L. Clifford McDonald
L. Clifford McDonald

Using high-risk antibiotics is an independent predictor of hospital-associated Clostridioides difficile infections, or HA CDIs, according to a study published in Infection Control & Hospital Epidemiology.

“We desired a more recent, updated assessment of the association between non-VA hospital antibiotic use and CDI incidence,” L. Clifford McDonald, MD, associate director for science in the CDC’s Division of Healthcare Quality Promotion, told Infectious Disease News. “We thought this might reflect changes in any association following recent changes in antibiotic use that may or may not be due to the efforts of stewardship programs.”

McDonald and colleagues evaluated previously defined high-risk antibiotic use in relation to CDI by analyzing 2016-2017 data from 171 hospitals found in the BD Insights Research Database. High-risk antibiotics included second-, third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems and lincosamides.

“We found that, overall, antibiotics identified in recent guidelines as ‘high risk’ continue to be a major proportion of overall antibiotic use - approximately half of all antibiotic use - and are associated with higher CDI rates,” McDonald said. The researchers wrote that cephalosporins were “significantly correlated” with HA CDI (R = 0.23; P < .01) when each class of high-risk antibiotics was evaluated.

According to the study, the overall HA CDI rate was 33 (interquartile range, 24-43) per 10,000 admissions and the overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003). A higher correlation was observed in teaching hospitals (0.38; P = .002). Additionally, for every 100 days (per 1,000 days present), researchers found an increase in high-risk antibiotic therapy, with a 12% increase in HA CDI (RR = 1.12; 95% CI, 1.04-1.21) after adjusting for confounders.

“Use of antibiotics can select for specific strains of C. difficile, some of which may be more virulent and likely to spread, causing serious infections and deaths. This is what happened with the fluoroquinolone-resistant 027 strain of C. difficile that emerged in the year 2000 and spread worldwide,” McDonald concluded. “This strain continues to be found in U.S. hospitals, but is waning. This decline in the 027 strain may be one reason we no longer see as strong an association between fluoroquinolone use and CDI rates. Because C. difficile in this way is acting like an antibiotic-resistant pathogen, our findings highlight why it will be important to continually relook over time at the associations of antibiotic use and resistance to advise local stewardship efforts in where to focus their efforts.”– by Caitlyn Stulpin

Disclosures: McDonald reports no relevant financial disclosures. Please see the full study for all authors’ financial disclosures.