US hospital data show link between antibiotic use, C difficile rates

Data from a cohort of US acute care hospitals (ACHs) reveal an association between total and broad-spectrum antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) rates, researchers from the Centers for Disease Control and Prevention (CDC) reported today in Infection Control & Hospital Epidemiology.

For the analysis, researchers examined data on antibiotic use, CDI tests, and CDI treatment at ACHs that reported data to the Premier Healthcare Database from 2012 through 2018. Hospital antibiotic use was measured in days of therapy (DOT) per 1,000 patient-days (PD) and examined through monthly rates of total antibiotic use and use of seven antibiotic classes. Facility-level HO-CDI rates were calculated per 10,000 PD.

Over the study period, among 921 participating hospitals, the median hospital-level HO-CDI rate was 6.7 per 10,000 PD. In a cross-sectional multivariable analysis, overall antibiotic use was significantly associated with the facility-level HO-CDI rate. For every 50 DOT per 1,000 PD increase in antibiotic use, there was a 2.8% increase in the HO-CDI rate. In an antibiotic class-specific model, 10 DOT per 1,000 PD increases in the use of carbapenems, cephalosporins, and piperacillin-tazobactam were each independently associated with 1.3%, 0.6%, and 1.1% increases in the HO-CDI rate, respectively.

Notably, four hospitals that reduced total antibiotic use by 30% or more saw a 40% decrease in HO-CDI rates. At 45 hospitals that saw reductions in their combined use of carbapenems, fluoroquinolones, and cephalosporins, annual decreases in the HO-CDI rate ranged from 4% to 16%.

“Although specific reasons for and factors driving the changes in antibiotic use in our hospital cohort were beyond the scope of this investigation, we found that decreased antibiotic use consistently corresponded with decreases in the HO-CDI rate,” the study authors wrote. “These findings should encourage ACHs to invest efforts into monitoring antibiotic use and targeting unnecessary and inappropriate use across all classes of antibiotics.”
May 7 Infect Control Hosp Epidemiol study

Study finds high rate of antibiotics for respiratory infections in rural China

A study conducted in rural China found a high rate of antibiotic prescribing, and frequent use of broad-spectrum antibiotics, for common respiratory tract infections, Chinese and British researchers reported yesterday in BMC Family Practice.

The study, conducted in one village clinic and one township health center in each of four residential areas in Anhui Province, involved non-participative observations, exit surveys, and a microbiologic study. A trained observer was sent to each clinic to record clinical diagnosis and antibiotic prescriptions and conduct semi-structured face-to-face interviews with patients to collect demographic data, disease history, and symptoms, and doctors collected sputum and throat swabs for bacterial culture and antibiotic susceptibility testing.

A total of 1,068 patients provided specimens and completed the surveys, with 638 providing sputum and 385 throat swabs. Overall, 30.5% received a diagnosis of respiratory tract infection, 23.3% were diagnosed as having bronchitis/tracheitis, 11.1% with pharyngitis, and 8% with “common cold.” Also, 88% were prescribed antibiotics; 36% of these prescriptions contained two or more types of antibiotics. The most commonly used antibiotics were penicillins, cephalosporins, and quinolones.

Of all the specimens tested, 30.8% were isolated with pathogenic bacteria. The most frequently isolated bacteria were Klebsiella pneumoniae (24%), Haemophilus influenzae (16%), Haemophilus parainfluenzae (15%), Pseudomonas aeruginosa (6%), and Staphylococus aureus (3%). High rates of resistance were found for K pneumoniae to ampicillin (97.4%), S aureus to penicillin (92.3%), and H influenzae to sulfamethoxazole (62.3%).

The study authors say the findings contradict a common belief among Chinese policymakers that the country’s antibiotic stewardship initiatives, which focus on antibiotic use at secondary and tertiary hospitals, are bringing excessive antibiotic use under control.

“Given that about 57% of China’s vast population lives in rural and township areas and over 70% of antibiotics prescriptions occur at settings in these areas, there is a clear need for added attention on excessive antibiotics use at these settings and communities,” they wrote.
May 6 BMC Fam Pract study