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Regional differences in Clostridium difficile infections in relation to fluoroquinolone and proton pump inhibitor use, Finland, 2008-2011
Abstract Background: Several antimicrobial agents and proton pump inhibitors (PPIs) have been identified as risk factors for Clostridium difficile infections (CDIs). Nationwide laboratory-based surveillance of CDIs in Finland since 2008 has shown variation in regional CDI rates. We evaluated whether...
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| Published in: | Infectious diseases (London, England) England), 2015-08, Vol.47 (8), p.530-535 |
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| Main Authors: | , , , , |
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| cites | cdi_FETCH-LOGICAL-c422t-e047458dc656ef1a7b2098769f685b5f22f0237a2e181e21faacb611972e62963 |
| container_end_page | 535 |
| container_issue | 8 |
| container_start_page | 530 |
| container_title | Infectious diseases (London, England) |
| container_volume | 47 |
| creator | Kanerva, Mari Ollgren, Jukka Voipio, Tinna Mentula, Silja Lyytikäinen, Outi |
| description | Abstract
Background: Several antimicrobial agents and proton pump inhibitors (PPIs) have been identified as risk factors for Clostridium difficile infections (CDIs). Nationwide laboratory-based surveillance of CDIs in Finland since 2008 has shown variation in regional CDI rates. We evaluated whether regional differences in CDI rates were associated with antibacterial and PPI use. Methods: Data on mean annual incidence rates of CDIs during 2008-2011 in 21 healthcare districts (HDs) were obtained from the National Infectious Disease Register, consumption (median annual use) of antimicrobials and PPIs from the Finnish Medical Agency, availability of molecular diagnostics by a laboratory survey and data on ribotypes from the national reference laboratory. The association over the 4 years was measured by incidence rate ratio (IRR) and we performed both bivariate and multivariate analyses. Results: During 2008-2011, PPI use increased 27% but fluoroquinolone use was stable. The level of fluoroquinolone use was strongly associated with the mean annual CDI incidence rate in different HDs over the 4-year period, but PPI use had less effect. The molecular diagnostics methodology and PCR ribotype 027 were not independently associated with CDI rate. The final multivariable model only included fluoroquinolone and PPI use; IRR for fluoroquinolones was 2.20 (95% confidence interval (CI), 1.32-3.67; p = 0.003). Conclusions: Fluoroquinolone use may play a role in regional differences in CDI rates. Although the use has not recently increased, regionally targeted antimicrobial stewardship campaigns promoting appropriate use of fluoroquinolones should still be encouraged since they may decrease the incidence of CDIs. |
| doi_str_mv | 10.3109/23744235.2015.1026933 |
| format | article |
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Background: Several antimicrobial agents and proton pump inhibitors (PPIs) have been identified as risk factors for Clostridium difficile infections (CDIs). Nationwide laboratory-based surveillance of CDIs in Finland since 2008 has shown variation in regional CDI rates. We evaluated whether regional differences in CDI rates were associated with antibacterial and PPI use. Methods: Data on mean annual incidence rates of CDIs during 2008-2011 in 21 healthcare districts (HDs) were obtained from the National Infectious Disease Register, consumption (median annual use) of antimicrobials and PPIs from the Finnish Medical Agency, availability of molecular diagnostics by a laboratory survey and data on ribotypes from the national reference laboratory. The association over the 4 years was measured by incidence rate ratio (IRR) and we performed both bivariate and multivariate analyses. Results: During 2008-2011, PPI use increased 27% but fluoroquinolone use was stable. The level of fluoroquinolone use was strongly associated with the mean annual CDI incidence rate in different HDs over the 4-year period, but PPI use had less effect. The molecular diagnostics methodology and PCR ribotype 027 were not independently associated with CDI rate. The final multivariable model only included fluoroquinolone and PPI use; IRR for fluoroquinolones was 2.20 (95% confidence interval (CI), 1.32-3.67; p = 0.003). Conclusions: Fluoroquinolone use may play a role in regional differences in CDI rates. Although the use has not recently increased, regionally targeted antimicrobial stewardship campaigns promoting appropriate use of fluoroquinolones should still be encouraged since they may decrease the incidence of CDIs.</description><identifier>ISSN: 2374-4235</identifier><identifier>EISSN: 2374-4243</identifier><identifier>DOI: 10.3109/23744235.2015.1026933</identifier><identifier>PMID: 25832317</identifier><language>eng</language><publisher>England: Informa Healthcare</publisher><subject>Anti-Bacterial Agents - adverse effects ; Clostridium difficile ; Clostridium difficile - classification ; Clostridium difficile - genetics ; Clostridium difficile - isolation & purification ; Clostridium Infections - epidemiology ; Clostridium Infections - prevention & control ; Cross Infection - epidemiology ; Drug Utilization ; Finland ; Finland - epidemiology ; fluoroquinolone ; Fluoroquinolones - adverse effects ; Humans ; Incidence ; Models, Statistical ; proton pump inhibitor ; Proton Pump Inhibitors - adverse effects ; ribotype ; Ribotyping ; Risk Factors ; Time Factors</subject><ispartof>Infectious diseases (London, England), 2015-08, Vol.47 (8), p.530-535</ispartof><rights>2015 Informa Healthcare 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-e047458dc656ef1a7b2098769f685b5f22f0237a2e181e21faacb611972e62963</citedby><cites>FETCH-LOGICAL-c422t-e047458dc656ef1a7b2098769f685b5f22f0237a2e181e21faacb611972e62963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25832317$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kanerva, Mari</creatorcontrib><creatorcontrib>Ollgren, Jukka</creatorcontrib><creatorcontrib>Voipio, Tinna</creatorcontrib><creatorcontrib>Mentula, Silja</creatorcontrib><creatorcontrib>Lyytikäinen, Outi</creatorcontrib><title>Regional differences in Clostridium difficile infections in relation to fluoroquinolone and proton pump inhibitor use, Finland, 2008-2011</title><title>Infectious diseases (London, England)</title><addtitle>Infect Dis (Lond)</addtitle><description>Abstract
Background: Several antimicrobial agents and proton pump inhibitors (PPIs) have been identified as risk factors for Clostridium difficile infections (CDIs). Nationwide laboratory-based surveillance of CDIs in Finland since 2008 has shown variation in regional CDI rates. We evaluated whether regional differences in CDI rates were associated with antibacterial and PPI use. Methods: Data on mean annual incidence rates of CDIs during 2008-2011 in 21 healthcare districts (HDs) were obtained from the National Infectious Disease Register, consumption (median annual use) of antimicrobials and PPIs from the Finnish Medical Agency, availability of molecular diagnostics by a laboratory survey and data on ribotypes from the national reference laboratory. The association over the 4 years was measured by incidence rate ratio (IRR) and we performed both bivariate and multivariate analyses. Results: During 2008-2011, PPI use increased 27% but fluoroquinolone use was stable. The level of fluoroquinolone use was strongly associated with the mean annual CDI incidence rate in different HDs over the 4-year period, but PPI use had less effect. The molecular diagnostics methodology and PCR ribotype 027 were not independently associated with CDI rate. The final multivariable model only included fluoroquinolone and PPI use; IRR for fluoroquinolones was 2.20 (95% confidence interval (CI), 1.32-3.67; p = 0.003). Conclusions: Fluoroquinolone use may play a role in regional differences in CDI rates. Although the use has not recently increased, regionally targeted antimicrobial stewardship campaigns promoting appropriate use of fluoroquinolones should still be encouraged since they may decrease the incidence of CDIs.</description><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Clostridium difficile</subject><subject>Clostridium difficile - classification</subject><subject>Clostridium difficile - genetics</subject><subject>Clostridium difficile - isolation & purification</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - prevention & control</subject><subject>Cross Infection - epidemiology</subject><subject>Drug Utilization</subject><subject>Finland</subject><subject>Finland - epidemiology</subject><subject>fluoroquinolone</subject><subject>Fluoroquinolones - adverse effects</subject><subject>Humans</subject><subject>Incidence</subject><subject>Models, Statistical</subject><subject>proton pump inhibitor</subject><subject>Proton Pump Inhibitors - adverse effects</subject><subject>ribotype</subject><subject>Ribotyping</subject><subject>Risk Factors</subject><subject>Time Factors</subject><issn>2374-4235</issn><issn>2374-4243</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkctu1DAUhi0EolXpI4C8ZNEMvsROvAI0ooBUCQnB2nKcY8aVEwfbEeoj8NY4nWklNrDy5XznP5cfoZeU7Dgl6g3jXdsyLnaMULGjhEnF-RN0vv03LWv508c7F2foMudbQgjlSjFKn6MzJnrOOO3O0e-v8MPH2QQ8eucgwWwhYz_jfYi5JD_6dboPeesD1IADW2rCPZMgmO2BS8QurDHFn6ufY4gzYDOPeEmx1OiyTkvFD37wJSa8ZrjC134OFbnCjJC-qWPQF-iZMyHD5em8QN-vP3zbf2puvnz8vH9_09iWsdIAabtW9KOVQoKjphsYUX0nlZO9GIRjzJE6umFAewqMOmPsIClVHQPJlOQX6PVRd9nahVz05LOFUNuBuGZNpRK0k3XPFRVH1KaYcwKnl-Qnk-40JXozQj8YoTcj9MmImvfqVGIdJhgfsx7WXoF3R6DuM6bJ_IopjLqYuxCTS2a2Pm_6_67x9i-JA5hQDtYk0LdxTdXR_J8u_wCEQqr-</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Kanerva, Mari</creator><creator>Ollgren, Jukka</creator><creator>Voipio, Tinna</creator><creator>Mentula, Silja</creator><creator>Lyytikäinen, Outi</creator><general>Informa Healthcare</general><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Regional differences in Clostridium difficile infections in relation to fluoroquinolone and proton pump inhibitor use, Finland, 2008-2011</title><author>Kanerva, Mari ; Ollgren, Jukka ; Voipio, Tinna ; Mentula, Silja ; Lyytikäinen, Outi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-e047458dc656ef1a7b2098769f685b5f22f0237a2e181e21faacb611972e62963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Clostridium difficile</topic><topic>Clostridium difficile - classification</topic><topic>Clostridium difficile - genetics</topic><topic>Clostridium difficile - isolation & purification</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - prevention & control</topic><topic>Cross Infection - epidemiology</topic><topic>Drug Utilization</topic><topic>Finland</topic><topic>Finland - epidemiology</topic><topic>fluoroquinolone</topic><topic>Fluoroquinolones - adverse effects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Models, Statistical</topic><topic>proton pump inhibitor</topic><topic>Proton Pump Inhibitors - adverse effects</topic><topic>ribotype</topic><topic>Ribotyping</topic><topic>Risk Factors</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kanerva, Mari</creatorcontrib><creatorcontrib>Ollgren, Jukka</creatorcontrib><creatorcontrib>Voipio, Tinna</creatorcontrib><creatorcontrib>Mentula, Silja</creatorcontrib><creatorcontrib>Lyytikäinen, Outi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Infectious diseases (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kanerva, Mari</au><au>Ollgren, Jukka</au><au>Voipio, Tinna</au><au>Mentula, Silja</au><au>Lyytikäinen, Outi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional differences in Clostridium difficile infections in relation to fluoroquinolone and proton pump inhibitor use, Finland, 2008-2011</atitle><jtitle>Infectious diseases (London, England)</jtitle><addtitle>Infect Dis (Lond)</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>47</volume><issue>8</issue><spage>530</spage><epage>535</epage><pages>530-535</pages><issn>2374-4235</issn><eissn>2374-4243</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract
Background: Several antimicrobial agents and proton pump inhibitors (PPIs) have been identified as risk factors for Clostridium difficile infections (CDIs). Nationwide laboratory-based surveillance of CDIs in Finland since 2008 has shown variation in regional CDI rates. We evaluated whether regional differences in CDI rates were associated with antibacterial and PPI use. Methods: Data on mean annual incidence rates of CDIs during 2008-2011 in 21 healthcare districts (HDs) were obtained from the National Infectious Disease Register, consumption (median annual use) of antimicrobials and PPIs from the Finnish Medical Agency, availability of molecular diagnostics by a laboratory survey and data on ribotypes from the national reference laboratory. The association over the 4 years was measured by incidence rate ratio (IRR) and we performed both bivariate and multivariate analyses. Results: During 2008-2011, PPI use increased 27% but fluoroquinolone use was stable. The level of fluoroquinolone use was strongly associated with the mean annual CDI incidence rate in different HDs over the 4-year period, but PPI use had less effect. The molecular diagnostics methodology and PCR ribotype 027 were not independently associated with CDI rate. The final multivariable model only included fluoroquinolone and PPI use; IRR for fluoroquinolones was 2.20 (95% confidence interval (CI), 1.32-3.67; p = 0.003). Conclusions: Fluoroquinolone use may play a role in regional differences in CDI rates. Although the use has not recently increased, regionally targeted antimicrobial stewardship campaigns promoting appropriate use of fluoroquinolones should still be encouraged since they may decrease the incidence of CDIs.</abstract><cop>England</cop><pub>Informa Healthcare</pub><pmid>25832317</pmid><doi>10.3109/23744235.2015.1026933</doi><tpages>6</tpages></addata></record> |
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| ispartof | Infectious diseases (London, England), 2015-08, Vol.47 (8), p.530-535 |
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| language | eng |
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| source | Taylor and Francis:Jisc Collections:Taylor and Francis Read and Publish Agreement 2024-2025:Medical Collection (Reading list) |
| subjects | Anti-Bacterial Agents - adverse effects Clostridium difficile Clostridium difficile - classification Clostridium difficile - genetics Clostridium difficile - isolation & purification Clostridium Infections - epidemiology Clostridium Infections - prevention & control Cross Infection - epidemiology Drug Utilization Finland Finland - epidemiology fluoroquinolone Fluoroquinolones - adverse effects Humans Incidence Models, Statistical proton pump inhibitor Proton Pump Inhibitors - adverse effects ribotype Ribotyping Risk Factors Time Factors |
| title | Regional differences in Clostridium difficile infections in relation to fluoroquinolone and proton pump inhibitor use, Finland, 2008-2011 |
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