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Antimicrobial Agents and Chemotherapy, May 2009, p. 2082-2088, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.01214-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

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{triangledown}

Mamoon A. Aldeyab,1 Stephan Harbarth,2 Nathalie Vernaz,3 Mary P. Kearney,4 Michael G. Scott,4 Chris Funston,4 Karen Savage,4 Denise Kelly,5 Motasem A. Aldiab,6 and James C. McElnay1*

Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, United Kingdom,1 Infection Control Program, University of Geneva Hospitals and Medical School, Geneva, Switzerland,2 Pharmacy Department, University of Geneva Hospitals and Medical School, Geneva, Switzerland,3 United Hospitals Trust, 45 Bush Road, Antrim BT42 2RL, Northern Ireland, United Kingdom,4 Whiteabbey Hospital, Doagh Road, Newtownabbey, County Antrim BT37 9RH, Northern Ireland, United Kingdom,5 German-Jordanian University, School of Informatics and Computing, P.O. Box 35247, Amman 11180, Jordan6

Received 12 September 2008/ Returned for modification 13 January 2009/ Accepted 1 March 2009

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.

* Corresponding author. Mailing address: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom. Phone: 44 28 90975177. Fax: 44 28 9043 4454. E-mail: j.mcelnay{at}qub.ac.uk

{triangledown} Published ahead of print on 16 March 2009.

Antimicrobial Agents and Chemotherapy, May 2009, p. 2082-2088, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.01214-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Kaier, K., Frank, U. (2009). Relationship between Antibiotic Consumption and Clostridium difficile-Associated Diarrhea: an Epidemiological Note. Antimicrob. Agents Chemother. 53: 4574-4575 [Full Text]  


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