Wassilew Nasstasja, Zehnder Alexandra, Atkinson Andrew, Kronenberg Andreas, Marschall Jonas
Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Infect Prev Pract. 2025 May 19;7(3):100468. doi: 10.1016/j.infpip.2025.100468. eCollection 2025 Sep.
infection is a common gastrointestinal disease in healthcare settings, ranging from uncomplicated diarrhoea to life-threatening pseudomembranous colitis. It is associated with increased morbidity, mortality and healthcare costs. The aim of the study was to correlate CDI incidence with total and specific antibiotic consumption across 17 clinical departments of an academic hospital.
This retrospective correlation study used data on CDI and antibiotic prescriptions from 1.1.2008 to 31.12.2021. CDI episodes were defined using CDC criteria. Antibiotic consumption was reported per WHO in defined daily doses (DDD). A mixed effects logistic regression model was fitted with each department as random effect to determine CDI incidence as a function of year and adjusted for antibiotic consumption.
Amoxicillin-clavulanate showed the highest annual consumption across the 17 departments (median 13.5 DDD/100 patient-days). The average CDI incidence was highest in nephrology (22.3/10'000 patient-days) and lowest in otorhinolaryngology (0.1/10'000 patient-days). We observed an association between overall antimicrobial consumption and CDI incidence (incidence risk ratio (IRR) per 10 DDD/100 patient-days of 1.16, 95% confidence interval (1.09, 1.23), <0.001). When plotting each department's CDI incidence against the departmental average annual consumption, no significant trend was found; however, there was a trend for the association between CDI and selected antibiotic usage, such as carbapenems (=0.003), ceftriaxone (=0.04), cefepime (<0.001), macrolides (<0.001) and piperacillin/tazobactam (=0.03).
We detected an association between antibiotic consumption and CDI incidence across the departments of an academic hospital; however, we could only correlate departmental CDI incidence with the usage of select antibiotics.
艰难梭菌感染（CDI）是医疗机构中一种常见的胃肠道疾病，范围从单纯性腹泻到危及生命的伪膜性结肠炎。它与发病率、死亡率增加以及医疗成本上升相关。本研究的目的是关联一所学术医院17个临床科室的CDI发病率与总的及特定抗生素消耗量。
这项回顾性关联研究使用了2008年1月1日至2021年12月31日期间CDI和抗生素处方的数据。CDI发作根据美国疾病控制与预防中心（CDC）标准定义。抗生素消耗量按世界卫生组织（WHO）规定的限定日剂量（DDD）报告。采用混合效应逻辑回归模型，将每个科室作为随机效应，以确定CDI发病率作为年份的函数，并针对抗生素消耗量进行调整。
阿莫西林克拉维酸在17个科室中的年消耗量最高（中位数为13.5 DDD/100患者日）。CDI平均发病率在肾病科最高（22.3/10000患者日），在耳鼻喉科最低（0.1/10000患者日）。我们观察到总体抗菌药物消耗量与CDI发病率之间存在关联（每10 DDD/100患者日的发病率风险比（IRR）为1.16，95%置信区间（1.09，1.23），P<0.001）。当绘制每个科室的CDI发病率与科室平均年消耗量的关系图时，未发现显著趋势；然而，CDI与某些特定抗生素使用之间存在关联趋势，如碳青霉烯类（P=0.003）、头孢曲松（P=0.04）、头孢吡肟（P<0.001）、大环内酯类（P<0.001）和哌拉西林/他唑巴坦（P=0.03）。
我们在一所学术医院的各科室中检测到抗生素消耗量与CDI发病率之间存在关联；然而，我们只能将科室CDI发病率与某些特定抗生素的使用相关联。
