Journal article

Authors list: Rohde, Anna M.; Mischnik, Alexander; Behnke, Michael; Dinkelacker, Ariane; Eisenbeis, Simone; Falgenhauer, Jane; Gastmeier, Petra; Haecker, Georg; Herold, Susanne; Imirzalioglu, Can; Kaeding, Nadja; Kramme, Evelyn; Peter, Silke; Piepenbrock, Ellen; Rupp, Jan; Schneider, Christian; Schwab, Frank; Seifert, Harald; Steib-Bauert, Michaela; Tacconelli, Evelina; Trauth, Janina; Vehreschild, Maria J. G. T.; Walker, Sarah, V; Kern, Winfried, V; Jazmati, Nathalie; DZIF R NET Study Grp

Publication year: 2023

Pages: 2274-2282

Journal: Journal of Antimicrobial Chemotherapy

Volume number: 78

Issue number: 9

ISSN: 0305-7453

eISSN: 1460-2091

DOI Link: https://doi.org/10.1093/jac/dkad232

Publisher: Oxford University Press

Abstract: 
Objectives To analyse the influence of antibiotic consumption on healthcare-associated healthcare onset (HAHO) Clostridioides difficile infection (CDI) in a German university hospital setting. Methods Monthly ward-level antibiotic consumption measured in DDD/100 patient days (pd) and CDI surveillance data from five university hospitals in the period 2017 through 2019 were analysed. Uni- and multivariable analyses were performed with generalized estimating equation models. Results A total of 225 wards with 7347 surveillance months and 4 036 602 pd participated. With 1184 HAHO-CDI cases, there was a median incidence density of 0.17/1000 pd (IQR 0.03-0.43) across all specialties, with substantial differences among specialties. Haematology-oncology wards showed the highest median incidence density (0.67/1000 pd, IQR 0.44-1.01), followed by medical ICUs (0.45/1000 pd, IQR 0.27-0.73) and medical general wards (0.32/1000 pd, IQR 0.18-0.53). Multivariable analysis revealed carbapenem (mostly meropenem) consumption to be the only antibiotic class associated with increased HAHO-CDI incidence density. Each carbapenem DDD/100 pd administered increased the HAHO-CDI incidence density by 1.3% [incidence rate ratio (IRR) 1.013; 95% CI 1.006-1.019]. Specialty-specific analyses showed this influence only to be valid for haematological-oncological wards. Overall, factors like ward specialty (e.g. haematology-oncology ward IRR 2.961, 95% CI 2.203-3.980) or other CDI cases on ward had a stronger influence on HAHO-CDI incidence density (e.g. community-associated CDI or unknown association case in same month IRR 1.476, 95% CI 1.242-1.755) than antibiotic consumption. Conclusions In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.

Harvard Citation style: Rohde, A., Mischnik, A., Behnke, M., Dinkelacker, A., Eisenbeis, S., Falgenhauer, J., et al. (2023) Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019, Journal of Antimicrobial Chemotherapy, 78(9), pp. 2274-2282. https://doi.org/10.1093/jac/dkad232

APA Citation style: Rohde, A., Mischnik, A., Behnke, M., Dinkelacker, A., Eisenbeis, S., Falgenhauer, J., Gastmeier, P., Haecker, G., Herold, S., Imirzalioglu, C., Kaeding, N., Kramme, E., Peter, S., Piepenbrock, E., Rupp, J., Schneider, C., Schwab, F., Seifert, H., Steib-Bauert, M., ...DZIF R NET Study Grp (2023). Association of ward-level antibiotic consumption with healthcare-associated Clostridioides difficile infections: an ecological study in five German university hospitals, 2017-2019. Journal of Antimicrobial Chemotherapy. 78(9), 2274-2282. https://doi.org/10.1093/jac/dkad232