Incidence of Clostridioides difficile infection (CDI) related to antibiotic prescribing by GP surgeries in Wales

Florence Tydeman*, Noel Craine, Kimberley Kavanagh, Helen Adams, Rosy Reynolds, Victoria McLure, Harriet Hughes, Matt Hickman, Chris Robertson

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

18 Downloads (Pure)

Abstract

Background: Clostridioides difficile infection (CDI) is a healthcare-acquired infection (HAI) causing significant morbidity and mortality. Welsh CDI rates are high in comparison to England and Scotland.
Objectives: This retrospective ecological study used aggregated disease surveillance data to understand the impact of total, and high-risk, Welsh general practitioner (GP) antibiotic prescribing of total, and stratified inpatient/ non-inpatient, CDI incidence.
Methods: All cases of confirmed CDI, during financial years 2014/15 -2017/18, were linked to aggregated rates of antibiotic prescribing in their GP surgery and classified as ‘inpatient’, ‘non-inpatient’ or ‘unknown’ by Public Health Wales. Multivariable negative-binomial regression models, comparing CDI incidence with antibiotic prescribing rates, were adjusted for potential confounders: location; age; social deprivation; co-morbidities (estimated from prevalence of key health indicators) and proton pump inhibitor (PPI) prescription rates.
Results: There were 4613 confirmed CDI cases, with an incidence of 1.44/1000 (95% CI, 1.40-1.48) registered patients. Unadjusted analysis showed an increased risk of total CDI incidence associated with higher total antibiotic prescribing (RR= 1.338, 95% CI 1.170 -1.529, per 1000 items per 1000 STAR-PU) and that high-risk antibiotic classes were positively associated with total CDI incidence. Location, age over 64 (%) and diabetes (%) were associated with increased risk of CDI. After adjusting for confounders, prescribing of clindamycin showed a positive association with total CDI incidence (RR=1.079, 95% CI 1.001 – 1.162 log items per 1000 registered patients).
Conclusions: An increased risk of CDI is demonstrated at a primary care practice population level reflecting their antibiotic prescribing rates, particularly clindamycin, and population demographics.
Original languageEnglish
Pages (from-to)2437-2445
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume76
Issue number9
Early online date21 Jun 2021
DOIs
Publication statusE-pub ahead of print - 21 Jun 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Fingerprint

Dive into the research topics of 'Incidence of Clostridioides difficile infection (CDI) related to antibiotic prescribing by GP surgeries in Wales'. Together they form a unique fingerprint.

Cite this