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J Med Microbiol 57 (2008), 709-716; DOI: 10.1099/jmm.0.47711-0
© 2008 Society for General Microbiology
ISSN 1473-5644

Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027

T. I. I. van der Kooi1, M. Koningstein1, A. Lindemans2, D. W. Notermans1, E. Kuijper3, R. van den Berg3, H. Boshuizen4, P. M. G. Filius2 and S. van den Hof1

1 Centre for Infectious Disease Control, RIVM Bilthoven, The Netherlands

2 Dutch Working Party on Antibiotic Policy (SWAB)/Erasmus Medical Center, Rotterdam, The Netherlands

3 Department of Medical Microbiology, Reference Laboratory for Clostridium difficile, Leiden University Medical Center, Leiden, The Netherlands

4 Expertise Centre for Methodology and Information Services, RIVM Bilthoven, The Netherlands

Correspondence
T. I. I. van der Kooi
tjallie.van.der.kooi{at}rivm.nl

Received 22 October 2007
Accepted 14 December 2007

The first Dutch outbreak due to Clostridium difficile ribotype 027 was observed in mid-2005; by the end of that year, eight hospitals were affected. To study the relationship between hospital-wide antibiotic use and the incidence of 027-linked C. difficile-associated disease (CDAD) three study groups were made: group A, all eight hospitals with an 027-associated epidemic; group B, five of a total of six hospitals with occasional 027 cases, without an increase in CDAD; and group C, ten randomly selected hospitals with no reported 027 epidemics or isolated 027 cases. Quarterly data on CDAD incidences, hygiene measures and the use of fluoroquinolones, second- and third-generation cephalosporins, extended-spectrum penicillins, penicillins with beta-lactamase inhibitors, carbapenems, lincomycins and macrolides were collected for 2004 and 2005, and divided into pre-epidemic and epidemic periods. Using a multilevel Poisson regression analysis, CDAD incidence was linked to antibiotic use in the previous quarter and to certain hygiene measures. In the pre-epidemic period, the total use of the studied antibiotics was comparable between affected and unaffected hospitals. Higher use of second-generation cephalosporins, macrolides and all of the studied antibiotics were independently associated with a small increase in CDAD incidence [relative risk (95 % confidence interval): 1.14 per increase of 100 defined daily doses per 10 000 bed days (1.06–1.23), 1.10 (1.01–1.19) and 1.02 (1.01–1.03), respectively]. However the effect was too small to predict which hospitals might be more prone to 027-associated outbreaks.

Abbreviations: CDAD, Clostridium difficile-associated disease; DDD, defined daily dose.




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