Clinical Pharmacology Department, Athens Medical Center, Marousi, Athens, 15125 Greece.
Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, 15123 Greece.
Infect Dis Health. 2022 Aug;27(3):119-128. doi: 10.1016/j.idh.2022.01.002. Epub 2022 Feb 10.
To investigate the association between Clostridioides difficile infection (CDI), antibiotic use, and infection control interventions, during an antibiotic stewardship program (ASP) implemented in a tertiary-care hospital in Greece from 2013 to 2018.
Analysis was applied for the following monthly indices: 1. consumption of antibiotics; 2. use of hand hygiene disinfectant solutions; 3. percentage of isolations of patients either with multidrug-resistant (MDR) bacteria, or CDI, or admitted from another hospital; and 4. percentage of patients with CDI divided into two groups: community-acquired CDI (CACDI) and hospital-associated CDI (HACDI) (onset ≤72 h and >72 h after admission, respectively).
During the study, a significant reduction in CACDI rate from 0.3%/admissions [95% CI 0.1-0.6] to 0.1%/admissions [95% CI 0.0-0.3] (p-value = 0.035) was observed in adults ICU, while CDI rates were stable in the rest of the hospital. Antibiotic consumption showed a significant reduction in total hospital, from 91.7 DDDs [95% CI 89.7-93.7] to 80.1 DDDs [95% CI 79.1-81.1] (p-value<0.001), except adults ICU. Non-advanced antibiotics correlated with decreased CDI rates in Adults Clinic Departments and ICU. Isolation of patients one and two months earlier correlated with decreased CACDI rates per 20% [95% CI 0.64-1.00, p-value = 0.046] and HACDI per 23% [95% CI 0.60-1.00, p-value = 0.050] in Adults Clinic Departments. Consumption of disinfectant solutions current month correlated with decreased rate for CACDI per 33% [95% CI 0.49-0.91, p-value = 0.011] and HACDI per 38% [95% CI 0.40-0.98, p-value = 0.040] in total Hospital Clinics.
Rational antibiotic prescribing during ASP along with multipronged intervention strategy focusing on hand hygiene and patient isolation measures prevent and control CDI outbreaks in the hospital setting.
本研究旨在调查 2013 年至 2018 年在希腊一家三级保健医院实施抗生素管理计划（ASP）期间，艰难梭菌感染（CDI）、抗生素使用和感染控制干预措施之间的关联。
对以下每月指标进行分析：1. 抗生素的使用量；2. 手部卫生消毒剂的使用量；3. 多重耐药菌（MDR）、CDI 或来自其他医院的患者的隔离率；4. 分为社区获得性 CDI（CACDI）和医院获得性 CDI（HACDI）两组的 CDI 患者比例（分别为入院后 72 小时内和 72 小时后发病）。
在研究期间，成人 ICU 的 CACDI 发生率从 0.3%/住院人次[95%CI0.1-0.6]显著下降至 0.1%/住院人次[95%CI0.0-0.3]（p 值=0.035），而医院其他科室的 CDI 发生率保持稳定。总住院患者的抗生素使用量从 91.7 DDDs[95%CI89.7-93.7]显著减少至 80.1 DDDs[95%CI89.1-91.1]（p 值<0.001），但成人 ICU 除外。成人内科和 ICU 科室中，非高级抗生素的使用与 CDI 发生率的下降相关。一个月和两个月前的患者隔离与成人内科科室中 CACDI 发生率分别降低 20%[95%CI0.64-1.00，p 值=0.046]和 HACDI 发生率降低 23%[95%CI0.60-1.00，p 值=0.050]相关。当月消毒剂的使用与总住院患者中 CACDI 发生率降低 33%[95%CI0.49-0.91，p 值=0.011]和 HACDI 发生率降低 38%[95%CI0.40-0.98，p 值=0.040]相关。
ASP 期间合理使用抗生素以及多管齐下的干预策略，重点关注手卫生和患者隔离措施，可预防和控制医院内 CDI 的爆发。
