Fortin Elise, Thirion Daniel J G, Ouakki Manale, Garenc Christophe, Lalancette Cindy, Bergeron Luc, Moisan Danielle, Villeneuve Jasmin, Longtin Yves
Montreal University Faculty of Medicine, Montreal, QC, Canada; Institut National de Santé Publique du Québec, Quebec City, QC, Canada.
McGill University Health Centre, Montreal, QC, Canada; Montreal University Faculty of Pharmacy, Montreal, QC, Canada.
Lancet Microbe. 2021 May;2(5):e182-e190. doi: 10.1016/S2666-5247(21)00005-7. Epub 2021 Mar 25.
The incidence of health-care-associated Clostridioides difficile infections has been declining in the Canadian province of Quebec since 2015. We examined whether changes in high-risk antibiotic use could account for this decrease, as reported in other jurisdictions.
We did a retrospective interrupted time-series analysis of 12 hospitals in the Canadian province of Quebec, representing a quarter of all health-care-associated C difficile infections in this region between April 1, 2012, and March 31, 2017. Data for high-risk antibiotic use (eg, amoxicillin-clavulanate, cephalosporins, fluoroquinolones, and clindamycin) in defined daily doses (DDDs) were extracted from local surveillance databases, and incidences of health-care-associated C difficile infections were extracted from provincial surveillance databases. We used hierarchical segmented Poisson regression to assess whether variations in rates of health-care-associated C difficile infections followed variations in antibiotic use.
Overall, 4455 health-care-associated C difficile infections and 6 281 960 patient-days were reported in the 12 participating hospitals, representing around a quarter of the provincial data. A 50% decrease in the annual incidence of health-care-associated C difficile infections was recorded between 2012-13 and 2016-17 (9·4 infections per 10 000 patient-days vs 4·7 infections per 10 000 patient-days), and a 67% decrease in the proportion of these infections due to the NAP1/027 strain of C difficile was seen (64% in 2013 vs 21% in 2017). In total, 1 266 960 DDDs of high-risk antibiotics were distributed during the study period. An increasing time trend was noted in high-risk antibiotic use, reaching a total of 223 DDDs per 1000 patient-days in 2016-17. An increase of one DDD per 1000 patient-days was associated with a 0·2% increase in the rate of health-care-associated C difficile infections in the following 4-week period. A significant change in incidence of health-care-associated C difficile infections persisted despite adjustment for high-risk antibiotic use, as shown by a significant residual step change (0·825, 95% CI 0·731-0·932) and change in trend (0·987, 0·980-0·994).
Changes in use of high-risk antibiotics do not entirely account for the sudden decrease in health-care-associated C difficile infections in the Canadian province of Quebec since 2015. Further studies are needed to understand factors implicated in the change in epidemiology of health-care-associated C difficile infections.
Institut National de Santé Publique du Québec.
自2015年以来，加拿大魁北克省医疗保健相关艰难梭菌感染的发病率一直在下降。我们研究了高危抗生素使用的变化是否可以解释这种下降，正如其他司法管辖区所报道的那样。
我们对加拿大魁北克省的12家医院进行了回顾性中断时间序列分析，这些医院占2012年4月1日至2017年3月31日该地区所有医疗保健相关艰难梭菌感染的四分之一。从当地监测数据库中提取以限定日剂量（DDD）表示的高危抗生素使用数据（如阿莫西林 - 克拉维酸、头孢菌素、氟喹诺酮类和克林霉素），并从省级监测数据库中提取医疗保健相关艰难梭菌感染的发病率。我们使用分层分段泊松回归来评估医疗保健相关艰难梭菌感染率的变化是否跟随抗生素使用的变化。
总体而言，12家参与研究的医院报告了4455例医疗保健相关艰难梭菌感染和6281960个患者日，约占省级数据的四分之一。2012 - 13年至2016 - 17年期间，医疗保健相关艰难梭菌感染的年发病率下降了50%（从每10000个患者日9.4例感染降至每10000个患者日4.7例感染），并且由艰难梭菌NAP1/027菌株引起的这些感染比例下降了67%（2013年为64%，2017年为21%）。在研究期间共分发了1266960个高危抗生素限定日剂量。高危抗生素使用呈现上升的时间趋势，在2016 - 17年达到每1000个患者日223个DDD。每1000个患者日增加1个DDD与接下来4周内医疗保健相关艰难梭菌感染率增加0.2%相关。尽管对高危抗生素使用进行了调整，但医疗保健相关艰难梭菌感染发病率仍存在显著变化，显著的残差阶跃变化（0.825，95%CI 0.731 - 0.932）和趋势变化（0.987，0.980 - 0.994）表明了这一点。
高危抗生素使用的变化并不能完全解释自2015年以来加拿大魁北克省医疗保健相关艰难梭菌感染的突然下降。需要进一步研究以了解与医疗保健相关艰难梭菌感染流行病学变化相关的因素。
魁北克国家公共卫生研究所。
