Background

Clostridioides difficile infections (CDI) are closely linked to antimicrobial consumption (AMC), posing a significant challenge for hospitals.

Objectives

This study examined the association between hospital-associated (HA)-CDI and AMC in Belgian hospitals from 2014 to 2023.

Methods

We conducted a retrospective observational study using two national surveillance datasets (CDI and AMC). Hospital-level AMC was stratified into low, moderate, and high consumption groups per year based on quartiles, both for overall antibiotic consumption and for consumption of antibiotic classes associated with increased CDI risk. A negative binomial mixed-effects regression model with hospital as a random intercept, adjusting for hospital type and region, was used to investigate these associations.

Results

No significant association was found between overall antibiotic consumption, beta-lactam/beta-lactamase inhibitors, cephalosporins (2^nd, 3^rd, and 4^th generation), clindamycin, and fluoroquinolones and HA-CDI incidence. In contrast, the level of consumption of carbapenems was significantly associated with HA-CDI: incidence rate ratios (IRRs) were 1.24 (95%CI 1.10-1.40) and 1.32 (95%CI 1.13-1.55) for moderate and high consumption, respectively (reference: low consumption, both p-value = 0.001). Glycopeptides showed a similar association, with IRRs of 1.32 (95%CI 1.17-1.49) and 1.34 (95%CI 1.32-1.34) for moderate and high consumption groups, respectively (both p < 0.001). Secondary hospitals exhibited higher HA-CDI rates compared to primary hospitals, even after adjusting for AMC and region.

Conclusion

These findings suggest that while AMC is a key driver of HA-CDI, other facility-related factors likely contribute. Strengthening antimicrobial stewardship and infection prevention and control measures is essential to reduce HA-CDI and antimicrobial resistance.