title: Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients.
abstract: The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78% of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect.
authors.affiliation: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom.
authors.forename: Mamoon A
authors.initials: MA
authors.lastname: Aldeyab
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vernaz
authors.forename: Mary P
authors.initials: MP
authors.lastname: Kearney
authors.forename: Michael G
authors.initials: MG
authors.lastname: Scott
authors.forename: Chris
authors.initials: C
authors.lastname: Funston
authors.forename: Karen
authors.initials: K
authors.lastname: Savage
authors.forename: Denise
authors.initials: D
authors.lastname: Kelly
authors.forename: Motasem A
authors.initials: MA
authors.lastname: Aldiab
authors.forename: James C
authors.initials: JC
authors.lastname: McElnay
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use*; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000187:drug effects*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D009660:Northern Ireland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D006635:Histamine H2 Antagonists