Outpatient antibiotic use linked to C. diff infections

Antibiotic use in the outpatient setting is a significant risk factor for contracting Clostridium difficile outside of a healthcare environment, according to a study published in the journal Open Forum Infectious Disease.

For the study, researchers used CDC C. difficile surveillance data to identify 226 patients who tested positive for C. difficile between 2014 and 2015. Selected participants had either tested positive for the infection as an outpatient or within three days of hospitalization, and had also not experienced an overnight stay in a healthcare facility in the previous 12 weeks. Researchers interviewed these patients on their health, medication use, recent healthcare visits, household exposures and diet. Additionally, researchers matched each patient with a healthy control with comparable demographics and conducted the same survey with these participants.

Researchers found higher rates of outpatient health services and antibiotic use among the C. difficile-infected cohort compared to participants who'd not experienced an infection. Eighty-two percent of those who experienced an infection reported a prior outpatient visit and 62 percent reported antibiotic use. For the control group, 58 percent reported an outpatient visit and 10 percent reported antibiotic use. Additionally, researchers found a visit to the emergency department to be associated with an increased risk of C. difficile infection independent of antibiotic use.

"There's a lot of work that needs to be done in terms of improving outpatient prescribing practices and making sure that providers are appropriately prescribing antibiotics," said Alice Guh, MD, a medical officer with the CDC and one of the study's authors. "Healthcare associated C. difficile infection is still a huge burden, but there is increasingly more recognition that community-associated C. difficile can occur. Outpatient antibiotic use is a risk factor, and we need to improve antibiotic stewardship not just in inpatient settings but also outpatient settings."

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