29. Building a Hospital “Antidiarrhgram”: Local Experiences with Clostridium difficile Infection and Frequently Used Antimicrobials
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area

Background: Clostridium difficile infection (CDI) risk impacts antimicrobial prescribing practices.  Institution-level data about CDI and frequently used antimicrobials may help to guide prescribers’ choices.

Methods: A retrospective cohort of adults tested for CDI at the University of New Mexico Hospital was formed.  Cases with CDI were compared to controls using logistic regression modeling.  Antimicrobials (not used to treat CDI) with >2000 recorded prescriptions in the cohort were eligible.  Unadjusted and adjusted odds ratios were calculated, estimating the association of CDI with the use of each antimicrobial within the preceding 180 days. 

Results: The cohort consisted of 5209 patients, including 1092 cases.  Eligible antimicrobials are shown in Table 1.  Ciprofloxacin, cephalexin, and cefazolin had independently higher odds of CDI after adjustment.  Unexpectedly, trimethoprim-sulfamethoxazole was among the strongest predictors, while clindamycin was not strongly predictive.

Conclusion: Institution-level data about CDI risk and frequently used antimicrobials may inform local prescribing practices and antimicrobial stewardship efforts.

Table 1. Antidiarrhgram for Clostridium difficile infection at the University of New Mexico Hospital

Unadjusted OR

(95% CI)

Adjusted OR

(95% CI) a

Ciprofloxacin

1.61 (1.38, 1.87)

1.51 (1.26, 1.80)

Cephalexin

1.93 (1.53, 2.45)

1.47 (1.13, 1.93)

Trimethoprim-sulfamethoxazole

1.75 (1.40, 2.19)

1.29 (0.99, 1.68) b

Cefazolin

1.31 (1.12, 1.53)

1.24 (1.04, 1.47)

Amoxicillin-clavulanate

1.43 (1.13, 1.82)

1.03 (0.78, 1.35)

Clindamycin

1.14 (0.93, 1.40)

0.97 (0.77, 1.22)

Ceftriaxone

1.23 (1.06, 1.43)

0.96 (0.79, 1.15)

Vancomycin (systemic routes)

1.15 (1.00, 1.32)

0.89 (0.73, 1.08)

Piperacillin-tazobactam

1.07 (0.92, 1.23)

0.87 (0.72, 1.05)

Cefepime

1.04 (0.89, 1.22)

0.86 (0.71, 1.03)

Fluconazole

1.02 (0.82, 1.29)

0.82 (0.63, 1.06)

Azithromycin

0.85 (0.68, 1.07)

0.69 (0.53, 0.89)

Doxycycline

0.81 (0.62, 1.07)

0.67 (0.49, 0.91)

OR: Odds ratio.  CI: Confidence interval.  a Adjusted model (n=4278) includes age, hospital unit type, prior exposure to statins or probiotics, and the number of other frequently used antibiotics.  b OR is the same after adjustment for steroid or proton pump inhibitor use.

Shane Wilder, BS, Martha Carvour, MD, PhD, Keenan Ryan, PharmD, PhC, Carla Walraven, PharmD, MS, Fares Qeadan, PhD, Kimberly Page, PhD, MPH, MS and Meghan Brett, MD, University of New Mexico Health Sciences Center, Albuquerque, NM

Disclosures:

S. Wilder, None

M. Carvour, None

K. Ryan, None

C. Walraven, None

F. Qeadan, None

K. Page, None

M. Brett, None

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