Inappropriate Antibiotic Use and Gastric Acid Suppression Preceding Clostridium difficile Infection.
Inappropriate Antibiotic Use and Gastric Acid Suppression Preceding Clostridium difficile Infection.
复制标题
艰难梭菌感染前抗生素使用不当和胃酸抑制。
DOI：
10.1017/ice.2016.2
复制
发表时间：
2016
影响因子：
4.5
通讯作者：
Morgan,DanielJ
中科院分区：
文献类型：
--
作者：
Croft,Lindsay;Ladd,James;Doll,Michelle;Morgan,DanielJ
Of all CDI episodes, 38.0%(27 of 71) were preceded by inappropriate gastric acid suppressant medications. For the 40 episodes in which gastric acid suppressant medications were used prior to CDI, 27 (67.5%) were inappropriately treated. The most common causes of inappropriate gastric acid suppression8 were prolonged treatment of GERD without recurrent symptoms or risk, peptic ulcer disease beyond 1 year, or inappropriate stress ulcer prophylaxis. Pneumonia, sepsis, skin and soft-tissue infections, and urinary tract infections were all common indications for antibiotics therapy. Inappropriate courses of antibiotics were most commonly initiated in long-term care (88.9% of courses inappropriate), outpatient clinics (72.7% inappropriate), and the emergency department (71.4% inappropriate). We found that CDI was often preceded by inappropriate antibiotics and inappropriate gastric acid suppressant medication. Prior CDI antibiotic use was often inappropriate due to absence of any evidence of infection or courses too long in duration. Once diagnosed with CDI, patients continued to receive inappropriate antibiotics. Antibiotics were more often inappropriate when started outside of acute care. Inappropriate gastric acid suppressant medication preceded more than a third of all CDI episodes.This study included a modest number of episodes of CDI. However, we included data regarding all CDI episodes for more than a year’within an integrated healthcare system, which also permitted more complete knowledge of antibiotic use prior to CDI diagnosis than studies focused solely in the acute care setting. 5 Additionally, our study is one of the first to examine frequency of inappropriate gastric acid suppression medications prior to CDI diagnosis and the frequency of continued inappropriate antibiotic use following CDI diagnosis. Despite hospitals increasing stewardship efforts, our results suggest that inappropriately prescribed antibiotics are still common before and after CDI diagnosis. Continued focus on reducing inappropriate antibiotic use and increased efforts to reduce inappropriate gastric acid suppressant use, both established risk factors for CDI, may represent an opportunity to decrease CDI. Emphasizing concrete patient-level risk of CDI may improve appropriate use of antibiotics and gastric acid suppressant medications.
