Temporal effects of antibiotic use and Clostridium difficile infections

Nathalie Vernaz, Kirsteen Hill, Stephanie Leggeat, Dilip Nathwani, Gabby Philips, Pascal Bonnabry, Peter Davey (Lead / Corresponding author)

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    Abstract

    We tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of Clostridium difficile infection in a hospital with stable incidence of infection at > 1 case per 1000 admissions per month.

    The study period was from April 2004 to June 2008 and used data from Infection Control and Hospital Pharmacy. We first described the monthly variation in C. difficile infection and then constructed a multivariate transfer function model that included lag time (cases of C. difficile infection in previous months and delays between changes in antibiotic use and changes in C. difficile infection).

    The average incidence of C. difficile infection was 1.5 cases per 1000 patients per month with no significant increase over 3 years. The number of cases of C. difficile infection in 1 month was dependent on the average number of cases of C. difficile infection in the previous 2 months. The models with data from the whole hospital showed a statistically significant relationship between the number of both hospital-acquired C. difficile infections and total C. difficile infections and consumption of piperacillin/tazobactam, ciprofloxacin and cefuroxime. The association between C. difficile infection and consumption of co-amoxiclav was only significant for hospital-acquired C. difficile infection. The model for hospital-acquired C. difficile infections explained 61% of the variance in C. difficile infections.

    These results provide support for antibiotic policies that minimize the use of broad-spectrum penicillins (co-amoxiclav and piperacillin/tazobactam), cephalosporins and fluoroquinolones.

    Original languageEnglish
    Pages (from-to)1272-1275
    Number of pages4
    JournalJournal of Antimicrobial Chemotherapy
    Volume63
    Issue number6
    DOIs
    Publication statusPublished - Jun 2009

    Keywords

    • time series analysis
    • hospital-acquired infections
    • piperacillin
    • tazobactam
    • cephalosporins
    • fluoroquinolones
    • co-amoxiclav
    • ANTIMICROBIAL RESISTANCE
    • SURVEILLANCE
    • DIARRHEA
    • MODEL
    • TIME

    Cite this

    Vernaz, N., Hill, K., Leggeat, S., Nathwani, D., Philips, G., Bonnabry, P., & Davey, P. (2009). Temporal effects of antibiotic use and Clostridium difficile infections. Journal of Antimicrobial Chemotherapy, 63(6), 1272-1275. https://doi.org/10.1093/jac/dkp128