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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Institutional spillover effects of antimicrobial use on antimicrobial resistance and Clostridioides difficile: a

Sumit Raybardhan1, Bradley Langford2, Russell Forrest1

  • 1University of Toronto Dalla Lana School of Public Health, Canada.

Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
|May 1, 2026
PubMed
Abstract

Insights

Antimicrobial use in institutions may increase the risk of antimicrobial resistance (AMR) and Clostridioides difficile infections in unexposed individuals. This systematic review highlights collateral risks, emphasizing the need for further research.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Epidemiology

Background:

  • Antimicrobial use (AMU) within healthcare settings can lead to the development of antimicrobial resistance (AMR) and infections like Clostridioides difficile.
  • Understanding the indirect effects, or spillover effects, of AMU on unexposed individuals is crucial for infection control.

Purpose of the Study:

  • To synthesize existing evidence on the institutional spillover effects of AMU on AMR and C. difficile infections in individuals not directly exposed to antimicrobials.

Main Methods:

  • A systematic review was conducted, searching three databases through August 2024.
  • Five observational studies were included, analyzing data from hospital wards and nursing homes.
  • A hybrid synthesis approach, including meta-analysis, was used, adhering to PRISMA guidelines.

Main Results:

  • Low to moderate quality evidence suggests a positive spillover effect: increased facility AMU is associated with higher collateral risks.
  • Meta-analysis of three studies indicated a pooled IRR of 1.54 (95% CI 0.85-2.80) per 100 days of therapy per 1,000 patient-days, with significant heterogeneity.

Conclusions:

  • Institutional AMU is associated with increased risks of AMR and C. difficile in unexposed individuals.
  • Methodological limitations and potential bias necessitate further research with standardized terminology and robust designs to clarify spillover mechanisms.

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