Rohde Anna M, Mischnik Alexander, Behnke Michael, Dinkelacker Ariane, Eisenbeis Simone, Falgenhauer Jane, Gastmeier Petra, Häcker Georg, Herold Susanne, Imirzalioglu Can, Käding Nadja, Kramme Evelyn, Peter Silke, Piepenbrock Ellen, Rupp Jan, Schneider Christian, Schwab Frank, Seifert Harald, Steib-Bauert Michaela, Tacconelli Evelina, Trauth Janina, Vehreschild Maria J G T, Walker Sarah V, Kern Winfried V, Jazmati Nathalie
German Centre for Infection Research (DZIF), Healthcare-Associated and Antibiotic-Resistant Bacterial Infections, Braunschweig, Germany.
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.
J Antimicrob Chemother. 2023 Sep 5;78(9):2274-2282. doi: 10.1093/jac/dkad232.
To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting.
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.
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.
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.
分析在一家德国大学医院环境中抗生素使用对医疗保健相关的医院获得性艰难梭菌感染（HAHO - CDI）的影响。
分析了2017年至2019年期间以限定日剂量（DDD）/100患者日（pd）衡量的每月病房级抗生素使用情况以及来自五所大学医院的CDI监测数据。使用广义估计方程模型进行单变量和多变量分析。
共有225个病房参与，监测时长7347个月，患者日数4036602天。在所有专科中，1184例HAHO - CDI病例的中位发病密度为0.17/1000患者日（IQR 0.03 - 0.43），各专科之间存在显著差异。血液肿瘤科病房的中位发病密度最高（0.67/1000患者日，IQR 0.44 - 1.01），其次是内科重症监护病房（0.45/1000患者日，IQR 0.27 - 0.73）和内科普通病房（0.32/1000患者日，IQR 0.18 - 0.53）。多变量分析显示，碳青霉烯类（主要是美罗培南）的使用是与HAHO - CDI发病密度增加相关的唯一抗生素类别。每100患者日给予一个碳青霉烯类DDD会使HAHO - CDI发病密度增加1.3%[发病率比（IRR）1.013；95% CI 1.006 - 1.019]。专科特异性分析表明，这种影响仅在血液肿瘤病房有效。总体而言，病房专科（如血液肿瘤科病房IRR 2.961，95% CI 2.203 - 3.980）或病房内其他CDI病例等因素对HAHO - CDI发病密度的影响（如同月社区相关CDI或关联不明病例IRR 1.476，95% CI 1.242 - 1.755）比抗生素使用更强。
在德国大学医院环境中，每月病房级碳青霉烯类药物的使用似乎主要增加了血液肿瘤病房的HAHO - CDI发病密度。此外，其他患者特异性因素对于控制HAHO - CDI似乎同样重要。
