Quantitative Analysis of the Association between Clinical Antimicrobial Use and Healthcare-associated Infections: A...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Healthcare-associated infections (HAIs) pose a significant threat to patient safety.
• Antimicrobial exposure is a known risk factor for HAIs, but the specific impact of regimen and duration requires further elucidation.

Purpose of the Study:

• To investigate the association between prior antimicrobial exposure, categorized by regimen and duration, and the risk of developing HAIs.
• To identify specific antimicrobial prescribing patterns associated with increased or decreased HAI risk.

Main Methods:

• A five-center case-control study comparing patients with HAIs to contemporaneous controls without HAIs.
• Stratification of controls by the Charlson Comorbidity Index (CCI) to account for patient complexity.
• Utilized restricted cubic spline analysis, subgroup analyses, and adjusted logistic regression to assess antimicrobial exposure duration and HAI risk.

Main Results:

• Prior antimicrobial exposure was more common in HAI cases than controls.
• Single-agent antimicrobial regimens (SAAR) were associated with reduced HAI risk (aOR 0.74), while two-agent (TAAR) (aOR 1.84) and multi-agent (MAAR) (aOR 2.59) regimens were independent risk factors.
• SAAR exposure ≤3 days (aOR 1.56) and TAAR exposure of 1-6 days (aOR 2.81) were significant independent risk factors for HAIs, showing J-shaped and U-shaped trends respectively.

Conclusions:

• SAAR appears relatively safe for HAI risk, especially when treatment exceeds 3 days.
• Caution is advised with co-administration of two or more antimicrobial agents due to increased HAI risk.
• Findings support optimizing antimicrobial stewardship to mitigate HAI incidence.