998. Defined Daily Doses of Antibiotic Consumption and Clostridium difficile Infection Rates in a University Hospital
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
  • DDDandCDIO.pdf (1.3 MB)
  • 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%.

    Laura Paláu-Dávila, M.D.1, Elvira Garza-Gonzalez, PhD2, Edelmiro Pérez-Rodríguez Sr., M.D., Ph.D.3 and Adrian Camacho-Ortiz, M.D., PhD1, (1)Infectious Diseases, University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, (2)Gastroenterology, University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, (3)Hospital Administration, University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico


    L. Paláu-Dávila, None

    E. Garza-Gonzalez, None

    E. Pérez-Rodríguez Sr., None

    A. Camacho-Ortiz, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.