Projects per year
Methods. Three National patient level datasets –covering CDI cases, community prescriptions and hospitalisations were linked by the NHS Scotland unique patient identifier, the community health index, CHI. All validated cases of CDI from August 2010 to July 2013 were extracted and up to six population-based controls were matched to each case from the CHI register for Scotland. Statistical analysis used conditional logistic regression.
Results. 1446 unique cases of CA-CDI were linked with 7964 age, sex and location matched controls. Cumulative exposure to any antimicrobial in the previous 6 months has a monotonic dose-response association with CA-CDI. Individuals with excess of 28 defined daily doses (DDD) to any antimicrobial (19.9% of cases) had an odds ratio (OR)=4.4 (95% CI:3.4-5.6) compared to those unexposed. Individuals exposed to 29+ DDD of high risk antimicrobials (cephalosporins, clindamycin co-amoxiclav, or fluoroquinolones) had an OR=17.9 (95% CI:7.6-42.2). Elevated CA-CDI risk following high risk antimicrobial exposure was greatest in the first month (OR=12.5 (8.9-17.4)) but was still present 4-6 months later (OR=2.6 (1.7-3.9)). Cases exposed to 29+DDD had prescription patterns more consistent with repeated therapeutic courses, using different antimicrobials, than long term prophylactic use.
Conclusions. This analysis demonstrated temporal and dose-response associations between CA-CDI risk and antimicrobials with an impact of exposure to high risk antimicrobials remaining 4-6 months later.
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- 1 Finished
The Scottish eHealth Informatics Research Centre (E-HIRCs) (Joint with Universities of Aberdeen, Glasgow, Edinburgh, Strathclyde, St Andrews & Leicester and ISD)
1/03/13 → 31/12/18