High-Risk Antibiotic Use Linked to Hospital-Associated C. Difficile

Hospital-level high-risk antibiotic use is associated with the risk for hospital-associated (HA) Clostridioides difficile infection (CDI), according to a study published online in Infection Control & Hospital Epidemiology.

Ying P. Tabak, Ph.D., from Becton, Dickinson and Co., in Franklin Lakes, New Jersey, and colleagues analyzed 2016 to 2017 data from 171 hospitals to assess previously defined high-risk antibiotic use in relation to CDIs. Second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides were included as high-risk antibiotics.

The researchers found that per 1,000 days present, the median days of therapy for high-risk antibiotic use were 241.2; per 10,000 admissions, the overall HA CDI rate was 33. High-risk antibiotic use was associated with HA CDI (correlation coefficient, 0.22), with a higher correlation in teaching hospitals (correlation coefficient, 0.38). After adjustment for confounders, for every 100-day increase in high-risk antibiotic therapy per 1,000 days present, the risk for HA CDI increased 12 percent (relative risk, 1.12).

"This highlights the importance of ongoing monitoring of antibiotic use in hospitals for patient safety as it relates to the effect of antibiotics on C. difficile infections," coauthor L. Clifford McDonald, M.D., medical epidemiologist at the U.S. Centers for Disease Control and Prevention, said in a statement. "In the future it will also be important to look at the effect of antibiotic use on both C. difficile infection and antibiotic resistance simultaneously, rather than examining each piece as separate endeavors."

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