title: Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027.
abstract: The first Dutch outbreak due to Clostridium difficile ribotype 027 was observed in mid-2005; by the end of that year, eight hospitals were affected. To study the relationship between hospital-wide antibiotic use and the incidence of 027-linked C. difficile-associated disease (CDAD) three study groups were made: group A, all eight hospitals with an 027-associated epidemic; group B, five of a total of six hospitals with occasional 027 cases, without an increase in CDAD; and group C, ten randomly selected hospitals with no reported 027 epidemics or isolated 027 cases. Quarterly data on CDAD incidences, hygiene measures and the use of fluoroquinolones, second- and third-generation cephalosporins, extended-spectrum penicillins, penicillins with beta-lactamase inhibitors, carbapenems, lincomycins and macrolides were collected for 2004 and 2005, and divided into pre-epidemic and epidemic periods. Using a multilevel Poisson regression analysis, CDAD incidence was linked to antibiotic use in the previous quarter and to certain hygiene measures. In the pre-epidemic period, the total use of the studied antibiotics was comparable between affected and unaffected hospitals. Higher use of second-generation cephalosporins, macrolides and all of the studied antibiotics were independently associated with a small increase in CDAD incidence [relative risk (95% confidence interval): 1.14 per increase of 100 defined daily doses per 10,000 bed days (1.06-1.23), 1.10 (1.01-1.19) and 1.02 (1.01-1.03), respectively]. However the effect was too small to predict which hospitals might be more prone to 027-associated outbreaks.
authors.affiliation: Centre for Infectious Disease Control, RIVM Bilthoven, The Netherlands.
authors.forename: T I I
authors.initials: TII
authors.lastname: van der Kooi
authors.affiliation: Centre for Infectious Disease Control, RIVM Bilthoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koningstein
authors.affiliation: Dutch Working Party on Antibiotic Policy (SWAB)/Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Lindemans
authors.affiliation: Centre for Infectious Disease Control, RIVM Bilthoven, The Netherlands.
authors.forename: D W
authors.initials: DW
authors.lastname: Notermans
authors.affiliation: Department of Medical Microbiology, Reference Laboratory for Clostridium difficile, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Kuijper
authors.affiliation: Department of Medical Microbiology, Reference Laboratory for Clostridium difficile, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: Expertise Centre for Methodology and Information Services, RIVM Bilthoven, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Boshuizen
authors.affiliation: Dutch Working Party on Antibiotic Policy (SWAB)/Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: P M G
authors.initials: PMG
authors.lastname: Filius
authors.affiliation: Centre for Infectious Disease Control, RIVM Bilthoven, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van den Hof
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000145:classification* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control; D004363:Drug Utilization; D004403:Dysentery / Q000453:epidemiology* / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D021521:Ribotyping; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents