Background: One of the main factors for the development of Clostridium difficile infection (CDI) and subsequent control measures are antibiotic over-prescription and antibiotic stewardship programs (ASP). The current study analyzes the relationship between time periods of higher hospital consumption of antibiotics and increased CDI rates despite an active ASP.
Methods: Retrospective analysis of hospital antibiotic prescription patterns and time association with peaks of CDI cases from January 2012 through July 2015. Antibiotics were classified in groups: Fluoroquinolones, Cephalosporins and Clindamycin. Defined daily doses (DDD) per 1000 patient-days were calculated based on WHO recommendations.
Results: Median rates of CDI were 0.22 cases x 1000 patient-days (mean 0.37 ± 0.36 cases x 1000 patient-days). The antibiotic total prescription was reduced during the study period (4990.34 ± 797.84 in 2012 vs. 4162.63 ± 548.48 after 2013 DDD x 1000 patient-days; CI 398.42-1256.99; p≤0.001). The reduction in antibiotic prescription was significant for FQ (1894.05 ± 614.42 vs. 606.65 ± 320.44 DDD x 1000 patient-days; p≤0.001). A significant increase in Cep use was observed with 2269.75 ± 341.86 in 2012 vs. 2897.39 ± 377.22 DDD x 1000 patient-days since 2013 (p≤0.001). When CDI rates were above the mean total hospital consumption on clindamycin was higher (p=0.04), as well as higher cephalosporin consumption in medical wards (p=0.023).
We identified 7 CDI outbreaks (CDI-O) throughout the study period; in 6 of those 7 months an excess of antibiotic consumption (EAC), during the previous 30 days of at least 1 of the 3 antibiotic groups, was observed (p≤0.001). Thus, when an EAC was registered a positive predictive value of 85.71%, negative predictive value of 55.5% and a positive likelihood ratio of 4.71 (95% CI 0.66-33.61) were calculated for a CDI-O during the next 30 days.
Conclusion: By analyzing time patterns and associations between antibiotic prescriptions we found a correlation between excess antibiotic consumption and CDI-O with a high PPV of 85.71%.
E. Pérez-Rodríguez Sr., None
A. Camacho-Ortiz, None
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