Sarah Alland1,2, Sally Munnoch1, Bianca Mills1, Michelle Bolte1, Dr Colleen Ma1, Dr Matthew Kelly2
1Hunter New England Local Health District, Newcastle, Australia, 2Australian National University, Canberra, Australia
Biography:
Sarah is a Master of Applied Epidemiology student at Hunter New England Public Health Unit and the Australian National University.
Sarah has previously worked in various roles at NSW Health including in the Centre for Population Health, the Population Health service at South Western Sydney Local Health District, Health Protection NSW and the Centre for Epidemiology and Evidence. She undertook operational and epidemiological roles in the NSW COVID-19 public health emergency response.
Sarah is a graduate of the NSW Public Health Training Program and also has a Master of Public Health from the University of NSW.
Abstract:
Introduction
Clostridioides difficile infection (CDI) is a diarrhoeal infection that causes increased morbidity and lengths of stay in hospitalised patients. From 2018 to 2022, a large, regional hospital experienced a sustained increase in patients with CDI. We conducted a retrospective case-control study to investigate the relationship between antimicrobial prescribing and hospital-acquired CDI at this hospital.
Methods
Seventy hospital-acquired CDI cases were selected for the study. Controls were randomly selected and matched with cases on a 1:2 basis, based on date of hospitalisation and age group. We conducted a multivariate analysis to explore possible risk factors for infection, including antibiotic usage, proton pump inhibitor usage, length of stay, previous hospitalisation, and comorbidities. We compared participants who had been prescribed antibiotics to determine if inappropriate antibiotic prescribing differed between cases and controls.
Results
Use of cephalosporins (OR 10.38, 95% CI 3.82 – 28.20), use of broad-spectrum penicillins (OR 12.34, 95% CI 4.06 – 37.56), use of fluoroquinolones (OR 15.96, 95% CI 1.41 – 181.16) and increased complexity of comorbidities (OR 1.25, 95% CI 1.03 – 1.52) were associated with CDI. Inappropriate antibiotic prescribing (OR 5.12, 95% CI 2.13 – 13.49) and non-compliance with antibiotic prescribing guidelines (OR 3.46, 95% CI 1.53 – 8.28) were more common in cases than controls.
Conclusion
Our study showed that antibiotic prescribing practices contributed to hospital-acquired CDI at the hospital during the study period. The results reinforce the importance of clinician compliance with antibiotic prescribing guidelines and provide further evidence for antimicrobial stewardship programs across the district.