Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection

• Type of Material: Article
• Authors: Raymund Dantes, Emory University; Yi Mu, Centers for Disease Control and Prevention; Lauri A. Hicks, Centers for Disease Control and Prevention; Jessica Cohen, Centers for Disease Control and Prevention; Wendy Bamberg, Colorado Department of Public Health and Environment; Zintars G. Beldavs, Oregon Health Authority; Ghinwa Dumyati, University of Rochester; Monica Farley, Emory University; Stacy Holzbauer, Minnesota Department of Health; James Meek, Connecticut Emerging Infections Program; Erin Phipps, University of New Mexico; Lucy Wilson, Johns Hopkins University; Lisa G. Winston, University of California San Francisco; L. Clifford McDonald, Centers for Disease Control and Prevention; Fernanda C. Lessa, Centers for Disease Control and Prevention
• Language: English
• Date: 2015-09-01
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: Copyright Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofv113
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 2
• Issue: 3
• Start Page: ofv113
• End Page: ofv113
• Grant/Funding Information: This work was supported by the Centers for Disease Control and Prevention Emerging Infections Program and the National Center for National Center for Emerging and Zoonotic Infectious Diseases.
• Keywords: UNITED-STATES; SURVEILLANCE; public health surveillance; DIARRHEA; SETTINGS; Science & Technology; Clostridium difficile; PRIMARY-CARE; ADULTS; EPIDEMIOLOGY; epidemiology; Infectious Diseases; Life Sciences & Biomedicine; antibacterial agents; TRACT-INFECTION; GUIDELINES; PREVENTION; outpatients
• Research Categories: Biology, Virology; Biology, Microbiology; Health Sciences, Public Health

Abstract

Background.  Antibiotic use predisposes patients to Clostridium difficile infections (CDI), and approximately 32% of these infections are community-associated (CA) CDI. The population-level impact of antibiotic use on adult CA-CDI rates is not well described. Methods.  We used 2011 active population- and laboratory-based surveillance data from 9 US geographic locations to identify adult CA-CDI cases, defined as C difficile-positive stool specimens (by toxin or molecular assay) collected from outpatients or from patients ≤3 days after hospital admission. All patients were surveillance area residents and aged ≥20 years with no positive test ≤8 weeks prior and no overnight stay in a healthcare facility ≤12 weeks prior. Outpatient oral antibiotic prescriptions dispensed in 2010 were obtained from the IMS Health Xponent database. Regression models examined the association between outpatient antibiotic prescribing and adult CA-CDI rates. Methods.  Healthcare providers prescribed 5.2 million courses of antibiotics among adults in the surveillance population in 2010, for an average of 0.73 per person. Across surveillance sites, antibiotic prescription rates (0.50-0.88 prescriptions per capita) and unadjusted CA-CDI rates (40.7-139.3 cases per 100 000 persons) varied. In regression modeling, reducing antibiotic prescribing rates by 10% among persons ≥20 years old was associated with a 17% (95% confidence interval, 6.0%-26.3%; P = .032) decrease in CA-CDI rates after adjusting for age, gender, race, and type of diagnostic assay. Reductions in prescribing penicillins and amoxicillin/clavulanic acid were associated with the greatest decreases in CA-CDI rates. Conclusions and Relevance.  Community-associated CDI prevention should include reducing unnecessary outpatient antibiotic use. A modest reduction of 10% in outpatient antibiotic prescribing can have a disproportionate impact on reducing CA-CDI rates.