Reductions in antibiotic use (AU), either in overall use or focused reductions in use of fluoroquinolones and third- and fourth-generation cephalosporins, may reduce facility-level rates of hospital-onset Clostridioides difficile (HO-CDI), a new study suggests. In this ecologic analysis, researchers examined cross-sectional and temporal associations between rates of hospital-level antibiotic use (AU) and HO-CDI using data from 549 US acute care hospitals. The found:

• During 2006-2012, the unadjusted annual rates of HO-CDI and total AU were 7.3 per 10,000 patient-days (PD) and 811 days of therapy (DOT) per 1,000 PD, respectively.
• In the cross-sectional analysis, for every 50 DOT per 1,000 PD increase in total AU, there was a 4.4% increase in HO-CDI.
• In time-series analysis, the 6 acute care hospitals with a ≥30% decrease in total AU had a 33% decrease in HO-CDI.
• Acute care hospitals with a ≥20% decrease in fluoroquinolone or third- and fourth-generation cephalosporin use had a corresponding decrease in HO-CDI of 8% and 13%, respectively.