Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019

Anna M Rohde; Alexander Mischnik; Michael Behnke; Ariane Dinkelacker; Simone Eisenbeis; Jane Falgenhauer; Petra Gastmeier; Georg Häcker; Susanne Herold; Can Imirzalioglu; Nadja Käding; Evelyn Kramme; Silke Peter; Ellen Piepenbrock; Jan Rupp; Christian Schneider; Frank Schwab; Harald Seifert; Michaela Steib-Bauert; Evelina Tacconelli; Janina Trauth; Maria J G T Vehreschild; Sarah V Walker; Winfried V Kern; Nathalie Jazmati; DZIF R-NET Study Group

doi:10.1093/jac/dkad232

Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019

J Antimicrob Chemother. 2023 Sep 5;78(9):2274-2282. doi: 10.1093/jac/dkad232.

Authors

Anna M Rohde^{1

2}, Alexander Mischnik^{1

3

4}, Michael Behnke^{1

2}, Ariane Dinkelacker^{1

5}, Simone Eisenbeis^{1

6}, Jane Falgenhauer^{1

7}, Petra Gastmeier^{1

2}, Georg Häcker^{1

8}, Susanne Herold^{1

9}, Can Imirzalioglu^{1

7}, Nadja Käding^{1

3}, Evelyn Kramme^{1

3}, Silke Peter^{1

5}, Ellen Piepenbrock^{1

10}, Jan Rupp^{1

3}, Christian Schneider^{1

8}, Frank Schwab^{1

2}, Harald Seifert^{1

10}, Michaela Steib-Bauert^{1

4}, Evelina Tacconelli^{1

6}, Janina Trauth^{1

9}, Maria J G T Vehreschild^{1

11

12}, Sarah V Walker^{1

10}, Winfried V Kern^{1

4}, Nathalie Jazmati^{1

10

13}; DZIF R-NET Study Group

Collaborators

Affiliations

¹ German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany.
² Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 27, 12203 Berlin, Germany.
³ Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Lübeck, Germany.
⁴ Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
⁵ Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
⁶ Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany.
⁷ Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany.
⁸ Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany.
⁹ University Hospital Giessen and Marburg, Department of Medicine V (Internal Medicine, Infectious Diseases and Infection Control), Justus-Liebig-University Giessen, Giessen, Germany, member of the German Centre for Lung Research (DZL), member of the German Centre for Infection Research (DZIF) Department of Internal Medicine (Infectiology).
¹⁰ Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹¹ Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
¹² Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt am Main, Germany.
¹³ Labor Dr. Wisplinghoff, Cologne, Germany.

PMID: 37527398
DOI: 10.1093/jac/dkad232

Abstract

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.

© 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.permissions@oup.com.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Carbapenems
Clostridioides difficile*
Clostridium Infections* / drug therapy
Clostridium Infections* / epidemiology
Cross Infection* / drug therapy
Cross Infection* / epidemiology
Hospitals, University
Humans
Incidence
Retrospective Studies

Substances

Anti-Bacterial Agents
Carbapenems
canertinib dihydrochloride