PMID- 31522695
OWN - NLM
STAT- MEDLINE
DCOM- 20200618
LR  - 20220822
IS  - 1559-6834 (Electronic)
IS  - 0899-823X (Print)
IS  - 0899-823X (Linking)
VI  - 40
IP  - 11
DP  - 2019 Nov
TI  - Hospital-level high-risk antibiotic use in relation to hospital-associated 
      Clostridioides difficile infections: Retrospective analysis of 2016-2017 data 
      from US hospitals.
PG  - 1229-1235
LID - 10.1017/ice.2019.236 [doi]
AB  - OBJECTIVE: Antibiotics are widely used by all specialties in the hospital 
      setting. We evaluated previously defined high-risk antibiotic use in relation to 
      Clostridioides difficile infections (CDIs). METHODS: We analyzed 2016-2017 data 
      from 171 hospitals. High-risk antibiotics included second-, third-, and 
      fourth-generation cephalosporins, fluoroquinolones, carbapenems, and 
      lincosamides. A CDI case was a positive stool C. difficile toxin or molecular 
      assay result from a patient without a positive result in the previous 8 weeks. 
      Hospital-associated (HA) CDI cases included specimens collected >3 calendar days 
      after admission or </=3 calendar days from a patient with a prior same-hospital 
      discharge within 28 days. We used the multivariable Poisson regression model to 
      estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, 
      controlling for confounders. RESULTS: The median days of therapy for high-risk 
      antibiotic use was 241.2 (interquartile range [IQR], 192.6-295.2) per 1,000 days 
      present; the overall HA CDI rate was 33 (IQR, 24-43) per 10,000 admissions. The 
      overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), 
      and higher correlation was observed in teaching hospitals (0.38; P = .002). For 
      every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, 
      there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04-1.21; P = .002) after 
      adjusting for confounders. CONCLUSIONS: High-risk antibiotic use is an 
      independent predictor of HA CDI. This assessment of poststewardship 
      implementation in the United States highlights the importance of tracking trends 
      of antimicrobial use over time as it relates to CDI.
FAU - Tabak, Ying P
AU  - Tabak YP
AD  - Becton, Dickinson and Co., Franklin Lakes, New Jersey.
FAU - Srinivasan, Arjun
AU  - Srinivasan A
AD  - Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Yu, Kalvin C
AU  - Yu KC
AD  - Becton, Dickinson and Co., Franklin Lakes, New Jersey.
FAU - Kurtz, Stephen G
AU  - Kurtz SG
AD  - Becton, Dickinson and Co., Franklin Lakes, New Jersey.
FAU - Gupta, Vikas
AU  - Gupta V
AD  - Becton, Dickinson and Co., Franklin Lakes, New Jersey.
FAU - Gelone, Steven
AU  - Gelone S
AD  - Nabriva Therapeutics US, King of Prussia, Pennsylvania.
FAU - Scoble, Patrick J
AU  - Scoble PJ
AD  - Nabriva Therapeutics US, King of Prussia, Pennsylvania.
FAU - McDonald, L Clifford
AU  - McDonald LC
AUID- ORCID: 0000-0003-3044-5572
AD  - Centers for Disease Control and Prevention, Atlanta, Georgia.
LA  - eng
GR  - CC999999/ImCDC/Intramural CDC HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190916
PL  - United States
TA  - Infect Control Hosp Epidemiol
JT  - Infection control and hospital epidemiology
JID - 8804099
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Bacterial Agents/*adverse effects
MH  - Clostridioides difficile/isolation & purification
MH  - Clostridium Infections/*epidemiology
MH  - Cross Infection/*epidemiology
MH  - Drug Utilization/*statistics & numerical data
MH  - Feces/microbiology
MH  - Hospitals/*statistics & numerical data
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Multivariate Analysis
MH  - Poisson Distribution
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - United States/epidemiology
PMC - PMC9390868
MID - NIHMS1829095
COIS- Conflicts of interest. Y.P.T., K.C.Y., S.G.K., V.G. are full-time employees of 
      Becton, Dickinson and Co., a medical technology company, whose life science 
      business segment develops, manufactures, and sells diagnostics for infectious 
      diseases, including CDI, as part of its business. S.G. is a full-time employee of 
      Nabriva. P.J.S. was a full-time employee of Nabriva at the time of this study. 
      A.S. and L.C.M. do not have any conflicts related to this article.
EDAT- 2019/09/17 06:00
MHDA- 2020/06/19 06:00
PMCR- 2022/08/19
CRDT- 2019/09/17 06:00
PHST- 2019/09/17 06:00 [pubmed]
PHST- 2020/06/19 06:00 [medline]
PHST- 2019/09/17 06:00 [entrez]
PHST- 2022/08/19 00:00 [pmc-release]
AID - S0899823X19002368 [pii]
AID - 10.1017/ice.2019.236 [doi]
PST - ppublish
SO  - Infect Control Hosp Epidemiol. 2019 Nov;40(11):1229-1235. doi: 
      10.1017/ice.2019.236. Epub 2019 Sep 16.