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Antibiotic Use and Hospital Onset CDI Infection

Clin Infect Dis; ePub 2019 Mar 1; Kazakova, et al

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.


Kazakova SV, Baggs J, McDonald LC, et al. Association between antibiotic use and hospital-onset Clostridioides difficile infection in U.S. acute care hospitals, 2006-2012: An ecologic analysis. [Published online ahead of print March 1, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz169.