Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients

M.A. Aldeyab, S. Harbarth, N. Vernaz, M.P. Kearney, M.G. Scott, C. Funston, K. Savage, D. Kelly, M.A. Aldiab, J.C. McElnay

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78% of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect. Copyright © 2009, American Society for Microbiology. All Rights Reserved.
LanguageEnglish
Pages2082-2088
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Volume53
Issue number5
Early online date24 Apr 2009
DOIs
Publication statusE-pub ahead of print - 24 Apr 2009

Fingerprint

Clostridium difficile
Gastric Acid
Infection Control
Diarrhea
Anti-Bacterial Agents
Incidence
Cephalosporins
Histamine Receptors
Amoxicillin-Potassium Clavulanate Combination
Northern Ireland
Fluoroquinolones
Macrolides
Teaching Hospitals
General Hospitals
Retrospective Studies

Keywords

  • alcohol
  • aminoglycoside
  • amoxicillin plus clavulanic acid
  • antiinfective agent
  • carbapenem
  • cephalosporin
  • chlorhexidine
  • glycopeptide
  • histamine H2 receptor antagonist
  • imidazole derivative
  • lincosamide
  • macrolide
  • nitrofuran derivative
  • proton pump inhibitor
  • quinoline derived antiinfective agent
  • tetracycline
  • trimethoprim
  • trimethoprim derivative
  • adolescent
  • adult
  • aged
  • article
  • child
  • Clostridium difficile infection
  • correlation analysis
  • drug use
  • hospital patient
  • human
  • incidence
  • infection control
  • major clinical study
  • morbidity
  • preschool child
  • priority journal
  • quasi experimental study
  • retrospective study
  • school child
  • time series analysis
  • United Kingdom
  • Aged
  • Anti-Bacterial Agents
  • Child, Preschool
  • Clostridium difficile
  • Diarrhea
  • Enterocolitis, Pseudomembranous
  • Histamine H2 Antagonists
  • Hospitals, Teaching
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Infection Control
  • Northern Ireland

Cite this

Aldeyab, M.A. ; Harbarth, S. ; Vernaz, N. ; Kearney, M.P. ; Scott, M.G. ; Funston, C. ; Savage, K. ; Kelly, D. ; Aldiab, M.A. ; McElnay, J.C. / Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients. In: Antimicrobial Agents and Chemotherapy. 2009 ; Vol. 53, No. 5. pp. 2082-2088.
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title = "Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients",
abstract = "The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78{\%} of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect. Copyright {\circledC} 2009, American Society for Microbiology. All Rights Reserved.",
keywords = "alcohol, aminoglycoside, amoxicillin plus clavulanic acid, antiinfective agent, carbapenem, cephalosporin, chlorhexidine, glycopeptide, histamine H2 receptor antagonist, imidazole derivative, lincosamide, macrolide, nitrofuran derivative, proton pump inhibitor, quinoline derived antiinfective agent, tetracycline, trimethoprim, trimethoprim derivative, adolescent, adult, aged, article, child, Clostridium difficile infection, correlation analysis, drug use, hospital patient, human, incidence, infection control, major clinical study, morbidity, preschool child, priority journal, quasi experimental study, retrospective study, school child, time series analysis, United Kingdom, Aged, Anti-Bacterial Agents, Child, Preschool, Clostridium difficile, Diarrhea, Enterocolitis, Pseudomembranous, Histamine H2 Antagonists, Hospitals, Teaching, Humans, Incidence, Infant, Infant, Newborn, Infection Control, Northern Ireland",
author = "M.A. Aldeyab and S. Harbarth and N. Vernaz and M.P. Kearney and M.G. Scott and C. Funston and K. Savage and D. Kelly and M.A. Aldiab and J.C. McElnay",
note = "Cited By :36 Export Date: 15 September 2018 CODEN: AMACC Correspondence Address: McElnay, J. C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: alcohol, 64-17-5; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; carbapenem, 83200-96-8; cephalosporin, 11111-12-9; chlorhexidine, 3697-42-5, 55-56-1; lincosamide, 80738-43-8; tetracycline, 23843-90-5, 60-54-8, 64-75-5; trimethoprim, 738-70-5; Anti-Bacterial Agents; Histamine H2 Antagonists References: Akhtar, A.J., Shaheen, M., Increasing incidence of Clostridium difficile-associated diarrhea in African-American and Hispanic patients: Association with the use of proton pump inhibitor therapy (2007) Journal of the National Medical Association, 99 (5), pp. 500-504; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Hughes, C.M., Scott, M.G., Kearney, M.P., Magee, F.A., McElnay, J.C., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J. Antimicrob. Chemother., 62, pp. 593-600; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Kearney, M.P., Clostridium difficile-associated diarrhoea in hospitalised patients (2000) Journal of Clinical Pharmacy and Therapeutics, 25 (2), pp. 101-109. , DOI 10.1046/j.1365-2710.2000.00266.x; Apisarnthanarak, A., Zack, J.E., Mayfield, J.L., Freeman, J., Dunne, W.M., Little, J.R., Mundy, L.M., Fraser, V.J., Effectiveness of environmental and infection control programs to reduce transmission of Clostridium difficile [3] (2004) Clinical Infectious Diseases, 39 (4), pp. 601-602. , DOI 10.1086/422523; Bartlett, J.G., Narrative review: The new epidemic of Clostridium difficile-associated enteric disease (2006) Ann. Intern. Med., 145, pp. 758-764; Baxter, R., Ray, G.T., Fireman, B.H., Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients (2008) Infect. Control Hosp. Epidemiol., 29, pp. 44-50; Braegger, C.P., Nadal, D., Clarithromycin and pseudomembranous enterocolitis [20] (1994) Lancet, 343 (8891), pp. 241-242; Cadle, R.M., Mansouri, M.D., Logan, N., Kudva, D.R., Musher, D.M., Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis (2007) American Journal of Health-System Pharmacy, 64 (22), pp. 2359-2363. , DOI 10.2146/ajhp060629; Dial, S., Alrasadi, K., Manoukin, C., Huang, A., Menzies, D., Risk of Clostridium difficile diaarhea among hospital inpatients prescribed proton pump inhibitors: Cohort and case-control studies (2004) Canadian Medical Association Journal, 171 (1), pp. 33-38. , DOI 10.1503/cmaj.1040876; Dial, S., Delaney, J.A.C., Barkun, A.N., Suissa, S., Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease (2005) Journal of the American Medical Association, 294 (23), pp. 2989-2995. , http://jama.ama-assn.org/cgi/reprint/294/23/2989, DOI 10.1001/jama.294.23.2989; Gerding, D.N., Muto, C.A., Owens Jr., R.C., Measures to control and prevent Clostridium difficile infection (2008) Clin. Infect. Dis., 46 (SUPPL. 1), pp. S43-S49; Guyot, A., Rawlins, M.D., Barrett, S.P., Clarithromycin appears to be linked with Clostridium difficile-associated diarrhoea in the elderly (2000) J. Antimicrob. Chemother., 46, pp. 642-643; Harris, A.D., Lautenbach, E., Perencevich, E., A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance (2005) Clinical Infectious Diseases, 41 (1), pp. 77-82. , DOI 10.1086/430713; Helfenstein, U., Box-Jenkins modelling in medical research (1996) Statistical Methods in Medical Research, 5 (1), pp. 3-22; Kazakova, S.V., Ware, K., Baughman, B., Bilukha, O., Paradis, A., Sears, S., Thompson, A., McDonald, L.C., A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile (2006) Arch. Intern. Med., 166, pp. 2518-2524; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scandinavian Journal of Gastroenterology, 32 (9), pp. 920-924; Long, S., Fenelon, L., Fitzgerald, S., Nolan, N., Burns, K., Hannan, M., Kyne, L., Drudy, D., First isolation and report of clusters of Clostridium difficile PCR 027 cases in Ireland (2007) Euro Surveill., 12, pp. E070426.3; Loo, V.G., Poirier, L., Miller, M.A., Oughton, M., Libman, M.D., Michaud, S., Bourgault, A.-M., Dascal, A., A predominantly clonal multi-institutional outbreak of Clostridium difficile - Associated diarrhea with high morbidity and mortality (2005) New England Journal of Medicine, 353 (23), pp. 2442-2449. , http://content.nejm.org/cgi/reprint/353/23/2442.pdf, DOI 10.1056/NEJMoa051639; McCusker, M.E., Harris, A.D., Perencevich, E., Roghmann, M.-C., Fluoroquinolone use and Clostridium difficile-associated diarrhea (2003) Emerging Infectious Diseases, 9 (6), pp. 730-733; McFarland, L.V., Clarridge, J.E., Beneda, H.W., Raugi, G.J., Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a veterans administration health care system (2007) Clinical Infectious Diseases, 45 (9), pp. 1141-1151. , DOI 10.1086/522187; McFarland, L.V., Update on the changing epidemiology of Clostridium difficile-associated disease (2008) Nat. Clin. Pract. Gastroenterol. Hepatol., 5, pp. 40-48; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev. Infect. Dis., 5, pp. 1033-1048; McMaster-Baxter, N.L., Musher, D.M., Clostridium difficile: Recent epidemiologic findings and advances in therapy (2007) Pharmacotherapy, 27 (7), pp. 1029-1039. , DOI 10.1592/phco.27.7.1029; Muto, C.A., Pokrywka, M., Shutt, K., Mendelsohn, A.B., Nouri, K., Posey, K., Roberts, T., Harrison, L.H., A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use (2005) Infection Control and Hospital Epidemiology, 26 (3), pp. 273-280. , DOI 10.1086/502539; Owens Jr., R.C., Donskey, C.J., Gaynes, R.P., Loo, V.G., Muto, C.A., Antimicrobial-associated risk factors for Clostridium difficile infection (2008) Clin. Infect. Dis., 46 (SUPPL. 1), pp. S19-S31; Pepin, J., Saheb, N., Coulombe, M.-A., Alary, M.-E., Conriveau, M.-P., Authier, S., Leblanc, M., Lanthier, L., Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: A cohort study during an epidemic in Quebec (2005) Clinical Infectious Diseases, 41 (9), pp. 1254-1260. , DOI 10.1086/496986; Samore, M.H., Venkataraman, L., DeGirolami, P.C., Merrigan, M.M., Johnson, S., Gerding, D.N., Carmeli, Y., Harbarth, S., Genotypic and phenotypic analysis of Clostridium difficile correlated with previous antibiotic exposure (2006) Microb. Drug Resist., 12, pp. 23-28; Schwaber, M.J., Simhon, A., Block, C., Roval, V., Ferderber, N., Shapiro, M., Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital (2000) European Journal of Clinical Microbiology and Infectious Diseases, 19 (1), pp. 9-15; Shardell, M., Harris, A.D., El-Kamary, S.S., Furuno, J.P., Miller, R.R., Perencevich, E.N., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clinical Infectious Diseases, 45 (7), pp. 901-907. , DOI 10.1086/521255; Starr, J.M., Martin, H., McCoubrey, J., Gibson, G., Poxton, I.R., Risk factors for Clostridium difficile colonisation and toxin production (2003) Age and Ageing, 32 (6), pp. 657-660. , DOI 10.1093/ageing/afg112; Thomas, C., Stevenson, M., Riley, T.V., Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: A systematic review (2003) Journal of Antimicrobial Chemotherapy, 51 (6), pp. 1339-1350. , DOI 10.1093/jac/dkg254; Thompson, I., Clostridium difficile-associated disease: Update and focus on non-antibiotic strategies (2008) Age Ageing, 37, pp. 14-18; Vernaz, N., Sax, H., Pittet, D., Bonnabry, P., Schrenzel, J., Harbarth, S., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J. Antimicrob. Chemother., 62, pp. 601-607; Vonberg, R.P., Kuijper, E.J., Wilcox, M.H., Barbut, F., T{\"u}ll, P., Gastmeier, P., Van Den Broek, P.J., Wiuff, C., Infection control measures to limit the spread of Clostridium difficile (2008) Clin. Microbiol. Infect., 14 (SUPPL. 5), pp. 2-20. , European C difficile-Infection Control Group, European Center for Disease Prevention and Control (ECDC); (2002) Guidelines for ATC Classifications and DDDs Assignment, , World Health Organization. Collaborating Center for Drug Statistics Methodology. World Health Organization Collaborating Center, Oslo, Norway",
year = "2009",
month = "4",
day = "24",
doi = "10.1128/AAC.01214-08",
language = "English",
volume = "53",
pages = "2082--2088",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
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}

Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients. / Aldeyab, M.A.; Harbarth, S.; Vernaz, N.; Kearney, M.P.; Scott, M.G.; Funston, C.; Savage, K.; Kelly, D.; Aldiab, M.A.; McElnay, J.C.

In: Antimicrobial Agents and Chemotherapy, Vol. 53, No. 5, 24.04.2009, p. 2082-2088.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients

AU - Aldeyab, M.A.

AU - Harbarth, S.

AU - Vernaz, N.

AU - Kearney, M.P.

AU - Scott, M.G.

AU - Funston, C.

AU - Savage, K.

AU - Kelly, D.

AU - Aldiab, M.A.

AU - McElnay, J.C.

N1 - Cited By :36 Export Date: 15 September 2018 CODEN: AMACC Correspondence Address: McElnay, J. C.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: j.mcelnay@qub.ac.uk Chemicals/CAS: alcohol, 64-17-5; amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; carbapenem, 83200-96-8; cephalosporin, 11111-12-9; chlorhexidine, 3697-42-5, 55-56-1; lincosamide, 80738-43-8; tetracycline, 23843-90-5, 60-54-8, 64-75-5; trimethoprim, 738-70-5; Anti-Bacterial Agents; Histamine H2 Antagonists References: Akhtar, A.J., Shaheen, M., Increasing incidence of Clostridium difficile-associated diarrhea in African-American and Hispanic patients: Association with the use of proton pump inhibitor therapy (2007) Journal of the National Medical Association, 99 (5), pp. 500-504; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Hughes, C.M., Scott, M.G., Kearney, M.P., Magee, F.A., McElnay, J.C., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J. Antimicrob. Chemother., 62, pp. 593-600; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Kearney, M.P., Clostridium difficile-associated diarrhoea in hospitalised patients (2000) Journal of Clinical Pharmacy and Therapeutics, 25 (2), pp. 101-109. , DOI 10.1046/j.1365-2710.2000.00266.x; Apisarnthanarak, A., Zack, J.E., Mayfield, J.L., Freeman, J., Dunne, W.M., Little, J.R., Mundy, L.M., Fraser, V.J., Effectiveness of environmental and infection control programs to reduce transmission of Clostridium difficile [3] (2004) Clinical Infectious Diseases, 39 (4), pp. 601-602. , DOI 10.1086/422523; Bartlett, J.G., Narrative review: The new epidemic of Clostridium difficile-associated enteric disease (2006) Ann. Intern. Med., 145, pp. 758-764; Baxter, R., Ray, G.T., Fireman, B.H., Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients (2008) Infect. Control Hosp. Epidemiol., 29, pp. 44-50; Braegger, C.P., Nadal, D., Clarithromycin and pseudomembranous enterocolitis [20] (1994) Lancet, 343 (8891), pp. 241-242; Cadle, R.M., Mansouri, M.D., Logan, N., Kudva, D.R., Musher, D.M., Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis (2007) American Journal of Health-System Pharmacy, 64 (22), pp. 2359-2363. , DOI 10.2146/ajhp060629; Dial, S., Alrasadi, K., Manoukin, C., Huang, A., Menzies, D., Risk of Clostridium difficile diaarhea among hospital inpatients prescribed proton pump inhibitors: Cohort and case-control studies (2004) Canadian Medical Association Journal, 171 (1), pp. 33-38. , DOI 10.1503/cmaj.1040876; Dial, S., Delaney, J.A.C., Barkun, A.N., Suissa, S., Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease (2005) Journal of the American Medical Association, 294 (23), pp. 2989-2995. , http://jama.ama-assn.org/cgi/reprint/294/23/2989, DOI 10.1001/jama.294.23.2989; Gerding, D.N., Muto, C.A., Owens Jr., R.C., Measures to control and prevent Clostridium difficile infection (2008) Clin. Infect. Dis., 46 (SUPPL. 1), pp. S43-S49; Guyot, A., Rawlins, M.D., Barrett, S.P., Clarithromycin appears to be linked with Clostridium difficile-associated diarrhoea in the elderly (2000) J. Antimicrob. Chemother., 46, pp. 642-643; Harris, A.D., Lautenbach, E., Perencevich, E., A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance (2005) Clinical Infectious Diseases, 41 (1), pp. 77-82. , DOI 10.1086/430713; Helfenstein, U., Box-Jenkins modelling in medical research (1996) Statistical Methods in Medical Research, 5 (1), pp. 3-22; Kazakova, S.V., Ware, K., Baughman, B., Bilukha, O., Paradis, A., Sears, S., Thompson, A., McDonald, L.C., A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile (2006) Arch. Intern. Med., 166, pp. 2518-2524; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scandinavian Journal of Gastroenterology, 32 (9), pp. 920-924; Long, S., Fenelon, L., Fitzgerald, S., Nolan, N., Burns, K., Hannan, M., Kyne, L., Drudy, D., First isolation and report of clusters of Clostridium difficile PCR 027 cases in Ireland (2007) Euro Surveill., 12, pp. E070426.3; Loo, V.G., Poirier, L., Miller, M.A., Oughton, M., Libman, M.D., Michaud, S., Bourgault, A.-M., Dascal, A., A predominantly clonal multi-institutional outbreak of Clostridium difficile - Associated diarrhea with high morbidity and mortality (2005) New England Journal of Medicine, 353 (23), pp. 2442-2449. , http://content.nejm.org/cgi/reprint/353/23/2442.pdf, DOI 10.1056/NEJMoa051639; McCusker, M.E., Harris, A.D., Perencevich, E., Roghmann, M.-C., Fluoroquinolone use and Clostridium difficile-associated diarrhea (2003) Emerging Infectious Diseases, 9 (6), pp. 730-733; McFarland, L.V., Clarridge, J.E., Beneda, H.W., Raugi, G.J., Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a veterans administration health care system (2007) Clinical Infectious Diseases, 45 (9), pp. 1141-1151. , DOI 10.1086/522187; McFarland, L.V., Update on the changing epidemiology of Clostridium difficile-associated disease (2008) Nat. Clin. Pract. Gastroenterol. Hepatol., 5, pp. 40-48; McGowan Jr., J.E., Antimicrobial resistance in hospital organisms and its relation to antibiotic use (1983) Rev. Infect. Dis., 5, pp. 1033-1048; McMaster-Baxter, N.L., Musher, D.M., Clostridium difficile: Recent epidemiologic findings and advances in therapy (2007) Pharmacotherapy, 27 (7), pp. 1029-1039. , DOI 10.1592/phco.27.7.1029; Muto, C.A., Pokrywka, M., Shutt, K., Mendelsohn, A.B., Nouri, K., Posey, K., Roberts, T., Harrison, L.H., A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use (2005) Infection Control and Hospital Epidemiology, 26 (3), pp. 273-280. , DOI 10.1086/502539; Owens Jr., R.C., Donskey, C.J., Gaynes, R.P., Loo, V.G., Muto, C.A., Antimicrobial-associated risk factors for Clostridium difficile infection (2008) Clin. Infect. Dis., 46 (SUPPL. 1), pp. S19-S31; Pepin, J., Saheb, N., Coulombe, M.-A., Alary, M.-E., Conriveau, M.-P., Authier, S., Leblanc, M., Lanthier, L., Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: A cohort study during an epidemic in Quebec (2005) Clinical Infectious Diseases, 41 (9), pp. 1254-1260. , DOI 10.1086/496986; Samore, M.H., Venkataraman, L., DeGirolami, P.C., Merrigan, M.M., Johnson, S., Gerding, D.N., Carmeli, Y., Harbarth, S., Genotypic and phenotypic analysis of Clostridium difficile correlated with previous antibiotic exposure (2006) Microb. Drug Resist., 12, pp. 23-28; Schwaber, M.J., Simhon, A., Block, C., Roval, V., Ferderber, N., Shapiro, M., Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital (2000) European Journal of Clinical Microbiology and Infectious Diseases, 19 (1), pp. 9-15; Shardell, M., Harris, A.D., El-Kamary, S.S., Furuno, J.P., Miller, R.R., Perencevich, E.N., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clinical Infectious Diseases, 45 (7), pp. 901-907. , DOI 10.1086/521255; Starr, J.M., Martin, H., McCoubrey, J., Gibson, G., Poxton, I.R., Risk factors for Clostridium difficile colonisation and toxin production (2003) Age and Ageing, 32 (6), pp. 657-660. , DOI 10.1093/ageing/afg112; Thomas, C., Stevenson, M., Riley, T.V., Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: A systematic review (2003) Journal of Antimicrobial Chemotherapy, 51 (6), pp. 1339-1350. , DOI 10.1093/jac/dkg254; Thompson, I., Clostridium difficile-associated disease: Update and focus on non-antibiotic strategies (2008) Age Ageing, 37, pp. 14-18; Vernaz, N., Sax, H., Pittet, D., Bonnabry, P., Schrenzel, J., Harbarth, S., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J. 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PY - 2009/4/24

Y1 - 2009/4/24

N2 - The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78% of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect. Copyright © 2009, American Society for Microbiology. All Rights Reserved.

AB - The objective of this study was to evaluate the effects of antimicrobial drug use, gastric acid-suppressive agent use, and infection control practices on the incidence of Clostridium difficile-associated diarrhea (CDAD) in a 426-bed general teaching hospital in Northern Ireland. The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (time-series analysis) model was built to relate CDAD incidence with antibiotic use, gastric acid-suppressive agent use, and infection control practices within the hospital over a 5-year period (February 2002 to March 2007). The findings of this study showed that temporal variation in CDAD incidence followed temporal variations in expanded-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.01/100 bed-days), broad-spectrum cephalosporin use (average delay = 2 months; variation of CDAD incidence = 0.02/100 bed-days), fluoroquinolone use (average delay = 3 months; variation of CDAD incidence = 0.004/100 bed-days), amoxicillin-clavulanic acid use (average delay = 1 month; variation of CDAD incidence = 0.002/100 bed-days), and macrolide use (average delay = 5 months; variation of CDAD incidence = 0.002/100 bed-days). Temporal relationships were also observed between CDAD incidence and use of histamine-2 receptor antagonists (H2RAs; average delay = 1 month; variation of CDAD incidence = 0.001/100 bed-days). The model explained 78% of the variance in the monthly incidence of CDAD. The findings of this study highlight a temporal relationship between certain classes of antibiotics, H2RAs, and CDAD incidence. The results of this research can help hospitals to set priorities for restricting the use of specific antibiotic classes, based on the size-effect of each class and the delay necessary to observe an effect. Copyright © 2009, American Society for Microbiology. All Rights Reserved.

KW - alcohol

KW - aminoglycoside

KW - amoxicillin plus clavulanic acid

KW - antiinfective agent

KW - carbapenem

KW - cephalosporin

KW - chlorhexidine

KW - glycopeptide

KW - histamine H2 receptor antagonist

KW - imidazole derivative

KW - lincosamide

KW - macrolide

KW - nitrofuran derivative

KW - proton pump inhibitor

KW - quinoline derived antiinfective agent

KW - tetracycline

KW - trimethoprim

KW - trimethoprim derivative

KW - adolescent

KW - adult

KW - aged

KW - article

KW - child

KW - Clostridium difficile infection

KW - correlation analysis

KW - drug use

KW - hospital patient

KW - human

KW - incidence

KW - infection control

KW - major clinical study

KW - morbidity

KW - preschool child

KW - priority journal

KW - quasi experimental study

KW - retrospective study

KW - school child

KW - time series analysis

KW - United Kingdom

KW - Aged

KW - Anti-Bacterial Agents

KW - Child, Preschool

KW - Clostridium difficile

KW - Diarrhea

KW - Enterocolitis, Pseudomembranous

KW - Histamine H2 Antagonists

KW - Hospitals, Teaching

KW - Humans

KW - Incidence

KW - Infant

KW - Infant, Newborn

KW - Infection Control

KW - Northern Ireland

U2 - 10.1128/AAC.01214-08

DO - 10.1128/AAC.01214-08

M3 - Article

VL - 53

SP - 2082

EP - 2088

JO - Antimicrobial Agents and Chemotherapy

T2 - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 5

ER -