Infectious Disease · Public Health · 1 h ago
Neighbourhood Antibiotic Use Linked to Community-Associated C. difficile Rates
An ecological study of 1,520 Ontario neighbourhoods found that higher antibiotic utilization was associated with higher community-associated C. difficile infection rates among adults aged 66 and older. The association was stronger for antibiotics classified as moderate or high risk, but the study cannot establish causation.
- Higher neighbourhood antibiotic use was associated with higher CA-CDI rates.
- The association was strongest for high-risk antibiotics.
- The ecological design cannot establish causation.
Researchers conducted a neighbourhood-level ecological study using province-wide data from Ontario, Canada, covering 2017–2023. The analysis included residents aged 66 years or older who had not been hospitalized in the preceding 30 days. Across 1,520 neighbourhoods, investigators compared antibiotic utilization—measured as days of therapy per 1,000 person-days—with incident community-associated C. difficile infection (CA-CDI) rates per 10,000 person-years. Negative-binomial regression adjusted for eight demographic and health care covariates.
The study identified 19,757 CA-CDI cases. Median antibiotic utilization was 21.1 days of therapy per 1,000 person-days (interquartile range, 16.7–25.6). Each 10-point increase in utilization was associated with a 13% higher CA-CDI rate (rate ratio, 1.13; 95% CI, 1.09–1.18). Associations differed by antibiotic risk category: rate ratios were 1.08 for low-risk, 1.27 for moderate-risk, and 1.73 for high-risk antibiotics.
These neighbourhood-level findings show an association, not that antibiotic use caused infections in individual patients. The study was limited to older adults in Ontario and used ecological data, so it does not establish which prescribing changes would reduce CA-CDI.
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Clinical Infectious Diseases: Association Between Neighbourhood-level Antibiotic Utilization and the Rate of Community-Associated C. difficile (CA-CDI) Infection: An Ecological Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.