Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections : an ecological study in five German university hospitals, 2017-2019
© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
OBJECTIVES: To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting.
METHODS: Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models.
RESULTS: A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption.
CONCLUSIONS: In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
The Journal of antimicrobial chemotherapy - 78(2023), 9 vom: 05. Sept., Seite 2274-2282 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rohde, Anna M [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 06.09.2023 Date Revised 07.09.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/jac/dkad232 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM360271847 |
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| 100 | 1 | |a Rohde, Anna M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections |b an ecological study in five German university hospitals, 2017-2019 |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 06.09.2023 | ||
| 500 | |a Date Revised 07.09.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a OBJECTIVES: To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting | ||
| 520 | |a METHODS: Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models | ||
| 520 | |a RESULTS: A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption | ||
| 520 | |a CONCLUSIONS: In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Carbapenems |2 NLM | |
| 650 | 7 | |a canertinib dihydrochloride |2 NLM | |
| 650 | 7 | |a ICJ93X8X90 |2 NLM | |
| 700 | 1 | |a Mischnik, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Behnke, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Dinkelacker, Ariane |e verfasserin |4 aut | |
| 700 | 1 | |a Eisenbeis, Simone |e verfasserin |4 aut | |
| 700 | 1 | |a Falgenhauer, Jane |e verfasserin |4 aut | |
| 700 | 1 | |a Gastmeier, Petra |e verfasserin |4 aut | |
| 700 | 1 | |a Häcker, Georg |e verfasserin |4 aut | |
| 700 | 1 | |a Herold, Susanne |e verfasserin |4 aut | |
| 700 | 1 | |a Imirzalioglu, Can |e verfasserin |4 aut | |
| 700 | 1 | |a Käding, Nadja |e verfasserin |4 aut | |
| 700 | 1 | |a Kramme, Evelyn |e verfasserin |4 aut | |
| 700 | 1 | |a Peter, Silke |e verfasserin |4 aut | |
| 700 | 1 | |a Piepenbrock, Ellen |e verfasserin |4 aut | |
| 700 | 1 | |a Rupp, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Schneider, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Schwab, Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Seifert, Harald |e verfasserin |4 aut | |
| 700 | 1 | |a Steib-Bauert, Michaela |e verfasserin |4 aut | |
| 700 | 1 | |a Tacconelli, Evelina |e verfasserin |4 aut | |
| 700 | 1 | |a Trauth, Janina |e verfasserin |4 aut | |
| 700 | 1 | |a Vehreschild, Maria J G T |e verfasserin |4 aut | |
| 700 | 1 | |a Walker, Sarah V |e verfasserin |4 aut | |
| 700 | 1 | |a Kern, Winfried V |e verfasserin |4 aut | |
| 700 | 1 | |a Jazmati, Nathalie |e verfasserin |4 aut | |
| 700 | 0 | |a DZIF R-NET Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Biehl, Lena |e investigator |4 oth | |
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| 700 | 1 | |a Chakraborty, Trinad |e investigator |4 oth | |
| 700 | 1 | |a Fitzenwanker, Moritz |e investigator |4 oth | |
| 700 | 1 | |a Gölz, Hanna |e investigator |4 oth | |
| 700 | 1 | |a Grundmann, Hajo |e investigator |4 oth | |
| 700 | 1 | |a Hennelly, Catriona |e investigator |4 oth | |
| 700 | 1 | |a Hölzl, Florian |e investigator |4 oth | |
| 700 | 1 | |a Kohlmorgen, Britta |e investigator |4 oth | |
| 700 | 1 | |a Künstle, Larissa |e investigator |4 oth | |
| 700 | 1 | |a Lang, Alexandra |e investigator |4 oth | |
| 700 | 1 | |a Lengler, Azita |e investigator |4 oth | |
| 700 | 1 | |a Lenke, Dana |e investigator |4 oth | |
| 700 | 1 | |a Diaz, Luis Alberto Peña |e investigator |4 oth | |
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| 700 | 1 | |a Schmiedel, Judith |e investigator |4 oth | |
| 700 | 1 | |a Thoma, Norbert |e investigator |4 oth | |
| 700 | 1 | |a Walinski, Bianca |e investigator |4 oth | |
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