Trends in incidence of long-term-care facility onset Clostridium difficile infections in 10 US geographic locations during 2011-2015

Guh, Alice; Mu, Yi; Baggs, James; Winston, Lisa G; Bamberg, Wendy; Lyons, Carol; Farley, Monica M.; Wilson, Lucy; Holzbauer, Stacy; Phipps, Erin C; Beldavs, Zintars G.; Kainer, Marion A.; Karlsson, Maria; Gerding, Dale N.; Dumyati, Ghinwa

doi:10.1016/j.ajic.2017.11.026

Cited by 22 publications

(12 citation statements)

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“…Given that ribotype 027 strains are now endemic in healthcare settings, our data suggest that fluoroquinolones might not be as important of a CDI risk factor as before considering the recent changes in CDI epidemiology 21. A recent article published in 2017 demonstrated that a concomitant decline in inpatient fluoroquinolone use and the NAP1/027 strain may have contributed to the decrease in the incidence rate of long-term-care facility-onset CDI from 2011 to 2015 22. Our results from the Cochran-Armitage Trend Test also indicated that there was a trend of decrease in CDI risk with fluoroquinolones from 2004 to 2017.…”

Section: Discussionmentioning

confidence: 81%

Clostridium difficile Infection Risk with Important Antibiotic Classes: An Analysis of the FDA Adverse Event Reporting System

et al. 2019

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Introduction: Antibiotic use is an important risk factor for Clostridium difficile infection (CDI). Prior meta-analyses have identified antibiotics and antibiotic classes that pose the greatest risk for CDI; however, CDI epidemiology is constantly changing and contemporary analyses are needed. Objectives: The objective of this study was to evaluate the association between CDI and important antibiotic classes in recent years using the FDA Adverse Event Report System (FAERS). Methods: FAERS reports from January 1, 2015 to December 31, 2017 were analyzed. The Medical Dictionary for Regulatory Activities (MedDRA) was used to identify CDI cases. We computed the Reporting Odds Ratios (RORs) and corresponding 95% confidence intervals (95%CI) for the association between antibiotics and CDI. An association was considered statistically significant when the lower limit of the 95%CI was greater than 1. Results: A total of 2,042,801 reports (including 5,187 CDI reports) were considered, after inclusion criteria were applied. Lincosamides (e.g., clindamycin) had the greatest proportion of CDI reports, representing 10.4% of all lincosamide reports. CDI RORs (95%CI) for the antibiotic classes were (in descending order): lincosamides 46.95 (39.49-55.82), monobactams 29.97 (14.60-61.54), penicillin combinations 20.05 (17.39-23.12), carbapenems 19.16 (15.52-23.67), cephalosporins/ monobactams/carbapenems 17.28 (14.95-19.97), cephalosporins 15.33 (12.60-18.65), tetracyclines 7.54 (5.42-10.50), macrolides 5.80 (4.48-7.51), fluoroquinolones 4.94 (4.20-5.81), and trimethoprim-sulfonamides 3.32 (2.03-5.43). Conclusion: All antibiotic classes included in the study were significantly associated with CDI. Lincosamides (e.g., clindamycin) had the highest CDI ROR among the antibiotics evaluated in this study.

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Section: Discussionmentioning

confidence: 81%

Clostridium difficile Infection Risk with Important Antibiotic Classes: An Analysis of the FDA Adverse Event Reporting System

et al. 2019

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“…proportions of different antibiotic classes among all oral antibiotics prescribed in the outpatient setting in the US are notably different from the corresponding proportions in England (compare Table 2 with Table 6). Those differences, particularly for fluoroquinolones and cephalosporins may be related to differences in the rates of severe bacterial infections, particularly Clostridium difficile (C. difficile) infections between the two countries [42], with reduction in fluoroquinolone and cephalosporin prescribing found to be associated with reduction in the incidence of C. difficile infection in both countries [43,44]. Table 4).…”

Section: Usmentioning

confidence: 99%

Prescribing of different antibiotics, rates of sepsis-related mortality and bacteremia in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing: a cross-sectional study

Goldstein

2019

Preprint

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Background Antibiotic use contributes to the rates of bacteremia, sepsis and associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on the rates of outcomes related to severe bacterial infections. Methods We looked at associations between the proportions (state-specific in the US; Clinical Commissioning Group (CCG)-specific in England) of different antibiotic types/classes among all prescribed antibiotics in the outpatient setting (oral antibiotics in the US), and rates of outcomes (mortality with sepsis, ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate in different age groups of US adults; E. coli as well as MSSA bacteremia in England) per unit of antibiotic prescribing (defined as the rate of outcome divided by the rate of outpatient prescribing of all antibiotics). Results In the US, prescribing of penicillins was associated with rates of mortality with sepsis for persons aged 75-84y and 85+y between 2014-2015. In England, prescribing of penicillins other than amoxicillin/co-amoxiclav was associated with rates of both MSSA and E. coli bacteremia for the period between financial years 2014/15 through 2017/18. Additionally, multivariable analysis for the US data has also shown an association between the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American and rates of mortality with sepsis in the corresponding age groups. Conclusions Our results suggest that prescribing of penicillins is associated with rates of E. coli and MSSA bacteremia in England, and rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of certain syndromes should be considered for reducing the rates of outcomes related to severe bacterial infections.

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“…14 Several recent studies, including that by Reveles et al, that document a decline in HCF CDI include patients of any age, usually adults aged 18 years and older. [13][14][15][22][23][24][25] As such, HCF CDI accounts for most episodes identified, ranging from 65% to 89% for those that defined both HCF and community-associated CDI. Declines in overall incidence, therefore, are not unexpected in populations for which the majority of episodes are HCF CDI, nor are comparisons between this study and those published contradictory; rather, our findings suggest trends in disease burden among those of younger age might differ from those of older age.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Clostridioides difficile infections among young and middle-aged adults: Veterans Health Administration

Russo

Kuntz

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.Design/Setting:A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.Patients/Methods:Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.Results:Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.Conclusions:The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.

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Trends in incidence of long-term-care facility onset Clostridium difficile infections in 10 US geographic locations during 2011-2015

Cited by 22 publications

References 9 publications

Clostridium difficile Infection Risk with Important Antibiotic Classes: An Analysis of the FDA Adverse Event Reporting System

Clostridium difficile Infection Risk with Important Antibiotic Classes: An Analysis of the FDA Adverse Event Reporting System

Prescribing of different antibiotics, rates of sepsis-related mortality and bacteremia in the US and England, and the utility of antibiotic replacement vs. reduction in prescribing: a cross-sectional study

Incidence of Clostridioides difficile infections among young and middle-aged adults: Veterans Health Administration

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