Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006-2012: An Ecologic Analysis
Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006-2012: An Ecologic Analysis
复制标题
DOI：
10.1093/cid/ciz169
复制
发表时间：
2020-01-01
影响因子：
11.8
通讯作者：
Jernigan, John A.
中科院分区：
文献类型：
--
作者：
Kazakova, Sophia, V;Baggs, James;Jernigan, John A.
背景不必要的抗生素使用（Au）导致艰难梭菌感染（CDI）率增加。抗生素限制对医院发生的CDI（HO-CDI）的影响尚未在美国急性护理医院（ACH）中进行评估。我们使用来自549个ACH的数据检查了医院级Au和HO-CDI率之间的横断面和时间相关性。HO-CDI定义为出院时有二级国际疾病分类，第九次修订，CDI临床修改代码（008.45），入院后接受甲硝唑或口服万古霉素治疗> 3天。采用多变量广义估计方程模型进行分析，调整患者和医院的特点。2006 - 2012年期间，HO-CDI和总Au的未校正年发生率分别为7.3/10000患者-天（PD）（95%置信区间[CI]，7.1 - 7.5）和811天治疗（DOT）/1000 PD（95% CI，803 - 820）。在横断面分析中，总Au每增加50 DOT/1000 PD，HO-CDI增加4.4%。第三代和第四代头孢菌素或碳青霉烯类的使用每增加10 DOT/1000 PD，HO-CDI分别增加2.1%和2.9%。在时间序列分析中，总Au减少>= 30%的6例ACH的HO-CDI减少33%（率比，0.67 [95% CI，0.47 - 0.96]）;氟喹诺酮或第三代和第四代头孢菌素使用减少>= 20%的ACH的HO-CDI相应减少分别为8%和13%。在生态学水平上，总Au的减少、氟喹诺酮类药物的使用以及第三代和第四代头孢菌素的使用均与HO-CDI率的降低相关。
Background. Unnecessary antibiotic use (AU) contributes to increased rates of Clostridioides difficile infection (CDI). The impact of antibiotic restriction on hospital-onset CDI (HO-CDI) has not been assessed in a large group of US acute care hospitals (ACHs).Methods. We examined cross-sectional and temporal associations between rates of hospital-level AU and HO-CDI using data from 549 ACHs. HO-CDI was defined as a discharge with a secondary International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI (008.45), and treatment with metronidazole or oral vancomycin > 3 days after admission. Analyses were performed using multivariable generalized estimating equation models adjusting for patient and hospital characteristics.Results. During 2006-2012, the unadjusted annual rates of HO-CDI and total AU were 7.3 per 10 000 patient-days (PD) (95% confidence interval [CI], 7.1-7.5) and 811 days of therapy (DOT)/1000 PD (95% CI, 803-820), respectively. In the cross-sectional analysis, for every 50 DOT/1000 PD increase in total AU, there was a 4.4% increase in HO-CDI. For every 10 DOT/1000 PD increase in use of third- and fourth-generation cephalosporins or carbapenems, there was a 2.1% and 2.9% increase in HO-CDI, respectively. In the time-series analysis, the 6 ACHs with a >= 30% decrease in total AU had a 33% decrease in HO-CDI (rate ratio, 0.67 [95% CI, .47-.96]); ACHs with a >= 20% decrease in fluoroquinolone or third- and fourth-generation cephalosporin use had a corresponding decrease in HO-CDI of 8% and 13%, respectively.Conclusions. At an ecologic level, reductions in total AU, use of fluoroquinolones, and use of third- and fourth-generation cephalosporins were each associated with decreased HO-CDI rates.