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JAC Advance Access originally published online on April 16, 2009
Journal of Antimicrobial Chemotherapy 2009 63(6):1272-1275; doi:10.1093/jac/dkp128
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Temporal effects of antibiotic use and Clostridium difficile infections

Nathalie Vernaz1, Kirsteen Hill2, Stephanie Leggeat3, Dilip Nathwani2, Gabby Philips3, Pascal Bonnabry1 and Peter Davey4,*

1 Department of Pharmacy, Hopitaux Universitaires de Geneva, Rue Michel du Crest 24, CH 12211 Geneva 14, Switzerland 2 Infection Unit, East Block, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK 3 Medical Microbiology and Infection Control, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK 4 Division of Community and Population Sciences and Education, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, Scotland, UK

Received 23 December 2008; returned 20 January 2009; revised 7 March 2009; accepted 7 March 2009

* Corresponding author. Tel: +44-1382-420000; Fax: +44-1382-420001; E-mail: p.g.davey{at}cpse.dundee.ac.uk

Objectives: We tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of Clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month.

Methods: The study period was from April 2004 to June 2008 and used data from Infection Control and Hospital Pharmacy. We first described the monthly variation in C. difficile infection and then constructed a multivariate transfer function model that included lag time (cases of C. difficile infection in previous months and delays between changes in antibiotic use and changes in C. difficile infection).

Results: The average incidence of C. difficile infection was 1.5 cases per 1000 patients per month with no significant increase over 3 years. The number of cases of C. difficile infection in 1 month was dependent on the average number of cases of C. difficile infection in the previous 2 months. The models with data from the whole hospital showed a statistically significant relationship between the number of both hospital-acquired C. difficile infections and total C. difficile infections and consumption of piperacillin/tazobactam, ciprofloxacin and cefuroxime. The association between C. difficile infection and consumption of co-amoxiclav was only significant for hospital-acquired C. difficile infection. The model for hospital-acquired C. difficile infections explained 61% of the variance in C. difficile infections.

Conclusions: These results provide support for antibiotic policies that minimize the use of broad-spectrum penicillins (co-amoxiclav and piperacillin/tazobactam), cephalosporins and fluoroquinolones.

Keywords: time series analysis , hospital-acquired infections , piperacillin/tazobactam , cephalosporins , fluoroquinolones , co-amoxiclav


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