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Stewardship / Resistance Scan for Feb 25, 2021
Danish study finds link between community C diff, proton pump inhibitors
A nationwide study in Denmark found an association between the use of proton pump inhibitors (PPIs) and increased risk of community-associated Clostridioides difficile infections (CA-CDI), Danish researcher reported today in Clinical Infectious Diseases.
For the study, researchers from Denmark’s Statens Serum Institute used the Danish National Microbiological Database to identify all incident episodes of CA-CDI in Danish adults from February 2010 through December 2013. They obtained data on filled prescriptions for PPIs, which neutralize or reduce the production of gastric acid, from the Danish National Prescription Registry.
The researchers conducted self-controlled case-series analyses to estimate incidence-rate ratios (IRRs) for CA-CDI, comparing periods with and without exposure to PPIs, and adjusted their models to account for confounders such as chronic disease, genetics, hospital stays, and antibiotic and corticosteroid use.
Of the 3,583 CA-CDI episodes identified, 964 occurred during current use of PPIs, 324 occurred 0 to 6 months after treatment cessation, 123 occurred 6 to 12 months after treatment cessation, and 2,172 occurred during periods with no use of PPIs. When the investigators compared the incidence of CA-CDI during current use of PPIs with periods of non-use, the unadjusted IRR was 2.78 (95% confidence interval [CI], 2.40 to 3.22). When adjusted for hospitalization, antibiotic use, and corticosteroid use, the IRR was 2.03 (95% CI, 1.74 to 2.36). The increased risk remained elevated for extended periods: 1.54 (95% CI, 1.31 to 1.80) for 0 to 6 months and 1.24 (95% CI, 1.00 to 1.53) for 6 to 12 months.
The study authors note that while previous observational studies have found varying levels of association between PPI use and CDI, the association has been questioned because of the absence of data from randomized controlled trials and insufficient adjustment for confounding factors.
“This large study with thorough control for confounding significantly adds to the body of evidence that increased risk of CDI, even in the community setting, should be considered when prescribing CDIs, although the underlying biological mechanisms need to be explored,” they write.
Feb 25 Clin Infect Dis study
Report examines social science insights on antibiotic use
The London School of Hygiene and Tropical Medicine (LSHTM) yesterday released a new report on antibiotic use in low- and middle-income countries (LMICs) that focuses on social science research and the emerging insights on novel ways to address antimicrobial resistance (AMR).
The report from LHSTM’s Fresh Approaches to the Study of Antimicrobials in Society project examines antibiotic use in LMICs through three different lenses: practices, structures, and networks. The idea behind the report, which combines insights gleaned from a growing body of published social science research into AMR and from a series of panel discussions held in 2020, is to formulate ideas of how these insights can be used to develop local interventions for addressing human and animal antibiotic use in a diverse range of settings.
Among the key themes identified in the report is that antibiotic use in many LMICs does not primarily result from a lack of knowledge about AMR but is related to a web of social, economic, political, and historic conditions, and that modifying how people in these countries use antibiotics requires addressing these issues. Another theme is that fractured healthcare systems and lack of access to clean water and sanitation infrastructure have become structural drivers of antibiotic use in many countries, and fixing these structures, rather than focusing on individual antibiotic use, could lead to longer-term solutions.
“In the last few years, there has been a growing acknowledgement of the vital role of social science in understanding and intervening on antibiotic use, a key driver of AMR,” author Clare Chandler, PhD, MSc, director of the LSHTM Antimicrobial Resistance Centre, writes in the report. “The growing concern that our off-the-shelf toolkit for addressing antibiotic use is insufficient in the face of rising use across humans, animals and plants, requires that we take a fresh look at the ways we are understanding this problem and possibilities for solutions.”
Feb 24 LSHTM report