Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019

DZIF R-NET Study Group, Anna M Rohde, Alexander Mischnik, Michael Behnke, Ariane Dinkelacker, Simone Eisenbeis, Jane Falgenhauer, Petra Gastmeier, Georg Häcker, Susanne Herold, Can Imirzalioglu, Nadja Käding, Evelyn Kramme, Silke Peter, Ellen Piepenbrock, Jan Rupp, Christian Schneider, Frank Schwab, Harald Seifert, Michaela Steib-BauertEvelina Tacconelli, Janina Trauth, Maria J G T Vehreschild, Sarah V Walker, Winfried V Kern, Nathalie Jazmati

Research output: Contribution to journalOriginal Articlepeer-review

Abstract

OBJECTIVES: To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting.

METHODS: Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models.

RESULTS: A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption.

CONCLUSIONS: In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.

Original languageEnglish
Pages (from-to)2274-2282
Number of pages9
JournalJOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume78
Issue number9
DOIs
Publication statusPublished - 5 Sept 2023

Keywords

  • Humans
  • Anti-Bacterial Agents/therapeutic use
  • Hospitals, University
  • Clostridioides difficile
  • Cross Infection/drug therapy
  • Carbapenems
  • Clostridium Infections/drug therapy
  • Incidence
  • Retrospective Studies

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