Antibiotic Exposure and Risk for Hospital-Associated Clostridioides difficile Infection

Area of Science:

• Infectious Diseases
• Epidemiology
• Antimicrobial Stewardship

Background:

• Clostridioides difficile infection (CDI) is a major healthcare-associated infection with substantial morbidity and economic impact.
• Existing prevention strategies for CDI are not always risk-based, necessitating further investigation into risk factors.
• Understanding population-specific risks is crucial for developing targeted and effective CDI prevention.

Purpose of the Study:

• To identify and evaluate risk factors for hospital-associated CDI within a large integrated healthcare system.
• To specifically assess the association between antibiotic exposure and the risk of developing CDI.
• To determine if certain antibiotic classes or routes of administration pose a higher risk for CDI.

Main Methods:

• Retrospective cohort study of adult admissions across 21 hospitals between 2006 and 2012.
• Identification of symptomatic hospital-onset and healthcare-facility-associated, community-onset CDI cases.
• Multivariable logistic regression analysis to evaluate the risk associated with prior and inpatient antibiotic exposure.

Main Results:

• A total of 2,356 CDI cases were identified among 506,068 admissions (incidence 46.6 per 10,000).
• Each prior day of antibiotic therapy increased the odds of subsequent CDI by 12.8% (95% CI, 12.2-13.4%).
• Higher CDI risk was associated with cephalosporins, carbapenems, fluoroquinolones, and clindamycin; doxycycline and daptomycin showed lower risk.

Conclusions:

• Cumulative antibiotic exposure prior to hospital admission is the most significant risk factor for developing CDI.
• The risk of CDI varies across different antibiotic classes and routes of administration.
• Findings can inform antimicrobial stewardship programs to optimize antibiotic use and reduce CDI incidence.