1213. Association between Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection
Session: Oral Abstract Session: New Insights into C. difficile Transmission and Reporting
Saturday, October 5, 2013: 8:30 AM
Room: The Moscone Center: 200-212

Background: Antibiotic use is a major risk factor for C. difficile infection. We determined the magnitude of the impact outpatient antibiotic prescriptions had on rates of community-associated C. difficile infection (CA-CDI).

Methods: Active population- and laboratory-based surveillance was performed in selected counties across 9 states in 2011; representing a population of 10.4 million persons. A CA-CDI case was defined as a C. difficile positive stool specimen (by toxin or molecular assay) collected as an outpatient or ≤3 days after hospital admission in a surveillance area resident aged ≥1 year, with no positive test in the prior 8 weeks, nor a documented overnight stay in a healthcare facility in the prior 12 weeks. Outpatient oral antibiotic prescriptions dispensed in 2010 in the same surveillance areas were extracted from the IMS Health© Xponent® database. US census denominators were used to calculate prescribing and CA-CDI rates. Pearson correlation coefficients and regression models were used to examine the association between antibiotic prescribing rates and CA-CDI rates.

Results: Healthcare providers prescribed 7.7 million courses of antibiotics among the surveillance population in 2010, or 0.73 per person. Rates were higher in females (0.87 prescriptions per capita), and among those <3 years old and ≥65 years old (1.2 and 0.97 prescriptions per capita, respectively). Across surveillance sites, antibiotic prescription rates (0.48-0.89 prescriptions per capita) and unadjusted CA-CDI rates (36.9-123.7 cases per 100,000 persons) varied; but antibiotic prescription rates positively correlated with CA-CDI rates (R=0.59, 95% Confidence Interval [CI] 0.38-0.74). In regression modeling, a 10% decrease in antibiotic prescribing rates among persons ≥20 years old was associated with a 16% (95% CI: 2.0-28.7%, P=0.027) decrease in CA-CDI rates after adjusting for age, gender, race, and use of nucleic acid amplification tests. Reductions in prescribing penicillins and β-lactam antibiotics with increased activity were associated with the greatest decreases in CA-CDI rates (Figure).

Conclusion: Prevention of CA-CDI should include outpatient antibiotic stewardship. Reducing outpatient antibiotic prescribing by 10% may decrease CA-CDI rates by up to 16%.

Raymund Dantes, MD, MPH1,2, Yi Mu, PhD1, Lauri A. Hicks, DO3, Jessica Cohen, MPH1,4, Wendy Bamberg, MD5, Zintars G. Beldavs, MS6, Ghinwa Dumyati, MD, FSHEA7, Monica M. Farley, MD8, Stacy Holzbauer, DVM, MPH, DACVPM9, James Meek, MPH10, Erin Phipps, DVM11, Lucy Wilson, MD12,13, Lisa G Winston, MD14,15, L. Clifford Mcdonald, MD1 and Fernanda Lessa, MD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Scientific Education Division Program Office, Centers for Disease Control and Prevention, Atlanta, GA, (3)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (4)Atlanta Research and Education Foundation, Atlanta, GA, (5)Colorado Dept. of Public Health and Environment, Denver, CO, (6)Oregon Health Authority, Portland, OR, (7)University of Rochester, Rochester, NY, (8)Emory University and Atlanta Veterans Administration Medical Center, Atlanta, GA, (9)CDC CEFO Assigned to the Minnesota Department of Health, St. Paul, MN, (10)Connecticut Emerging Infections Program, New Haven, CT, (11)University of New Mexico, Albuquerque, NM, (12)Maryland Emerging Infections Program, Baltimore, MD, (13)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (14)University of California, San Francisco/San Francisco General Hospital, San Francisco, CA, (15)California Emerging Infections Program, Oakland, CA


R. Dantes, None

Y. Mu, None

L. A. Hicks, None

J. Cohen, None

W. Bamberg, None

Z. G. Beldavs, None

G. Dumyati, None

M. M. Farley, None

S. Holzbauer, None

J. Meek, None

E. Phipps, None

L. Wilson, None

L. G. Winston, None

L. C. Mcdonald, None

F. Lessa, None

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