Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica

Background: Exposure to antimicrobials and Proton Pump Inhibitors (PPIs) are modifiable risk factors for nosocomial Clostridiodes difficile infection (CDI). We investigated the association between these agents and nosocomial CDI over five years. Methods: Nosocomial CDI from January 2017 to December...

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Autores: Fernández-Barrantes, Cristina, Ramos-Esquivel, Allan, Hernández-Soto, Luis Esteban, Ramírez-Cardoce, Manuel, Garro-Zamora, Luis David, Castro Cordero, Jose, Grau Cerrato, Santiago
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/72772
Acceso en línea:https://hdl.handle.net/10230/72772
http://dx.doi.org/10.3390/antibiotics14040350
Access Level:acceso abierto
Palabra clave:Clostridiodes difficile infection
Antibiotic prescription
Antimicrobial consumption
Defined daily doses
Pump proton inhibitors consumption
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spelling Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa RicaFernández-Barrantes, CristinaRamos-Esquivel, AllanHernández-Soto, Luis EstebanRamírez-Cardoce, ManuelGarro-Zamora, Luis DavidCastro Cordero, JoseGrau Cerrato, SantiagoClostridiodes difficile infectionAntibiotic prescriptionAntimicrobial consumptionDefined daily dosesPump proton inhibitors consumptionBackground: Exposure to antimicrobials and Proton Pump Inhibitors (PPIs) are modifiable risk factors for nosocomial Clostridiodes difficile infection (CDI). We investigated the association between these agents and nosocomial CDI over five years. Methods: Nosocomial CDI from January 2017 to December 2021 were included. Consumption trends were analyzed using a simple linear regression model. A correlation analysis was performed using Spearman's test in two ways: without a time interval and with 1-month interval matching. An interrupted time-series method to evaluate the impact of three key temporal breakpoints on CDI incidence rate was performed using the Poisson regression model. Results: A downward trend for cephalexin, ceftriaxone, clindamycin, gentamicin, macrolides, metronidazole, and penicillin sodium was identified. In contrast, an upward trend was recognized for amoxicillin, ceftazidime/avibactam, ertapenem, fluconazole, ketoconazole, levofloxacin, and tigecycline. Among the antimicrobials that showed a positive association between consumption and the incidence of CDI are clindamycin and cephalosporins after immediate consumption. Moreover, macrolides and metronidazole presented a positive correlation, in both immediate and delayed consumption. PPIs consumption did not show changes and was not associated with nosocomial CDI incidence. The interrupted time series analysis showed no changes at the breakpoints selected. Conclusions: Consumption of clindamycin, cephalosporins, and macrolides showed positive association with CDI, despite having a downtrend in consumption. Specific events, such as the COVID-19 pandemic and the implementation of ASP, have had no correlation with CDI. Further analysis is required in Latin America to advance our understanding of risk factors associated with CDI.MDPI2026202620252026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/10230/72772http://dx.doi.org/10.3390/antibiotics14040350reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésAntibiotics. 2025;14(4):350© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/727722026-06-12T07:21:37Z
dc.title.none.fl_str_mv Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
title Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
spellingShingle Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
Fernández-Barrantes, Cristina
Clostridiodes difficile infection
Antibiotic prescription
Antimicrobial consumption
Defined daily doses
Pump proton inhibitors consumption
title_short Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
title_full Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
title_fullStr Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
title_full_unstemmed Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
title_sort Association between antimicrobials and pump proton inhibitors consumption with the incidence of nosocomial Clostridiodes difficile infection in high complexity hospitals in Costa Rica
dc.creator.none.fl_str_mv Fernández-Barrantes, Cristina
Ramos-Esquivel, Allan
Hernández-Soto, Luis Esteban
Ramírez-Cardoce, Manuel
Garro-Zamora, Luis David
Castro Cordero, Jose
Grau Cerrato, Santiago
author Fernández-Barrantes, Cristina
author_facet Fernández-Barrantes, Cristina
Ramos-Esquivel, Allan
Hernández-Soto, Luis Esteban
Ramírez-Cardoce, Manuel
Garro-Zamora, Luis David
Castro Cordero, Jose
Grau Cerrato, Santiago
author_role author
author2 Ramos-Esquivel, Allan
Hernández-Soto, Luis Esteban
Ramírez-Cardoce, Manuel
Garro-Zamora, Luis David
Castro Cordero, Jose
Grau Cerrato, Santiago
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Clostridiodes difficile infection
Antibiotic prescription
Antimicrobial consumption
Defined daily doses
Pump proton inhibitors consumption
topic Clostridiodes difficile infection
Antibiotic prescription
Antimicrobial consumption
Defined daily doses
Pump proton inhibitors consumption
description Background: Exposure to antimicrobials and Proton Pump Inhibitors (PPIs) are modifiable risk factors for nosocomial Clostridiodes difficile infection (CDI). We investigated the association between these agents and nosocomial CDI over five years. Methods: Nosocomial CDI from January 2017 to December 2021 were included. Consumption trends were analyzed using a simple linear regression model. A correlation analysis was performed using Spearman's test in two ways: without a time interval and with 1-month interval matching. An interrupted time-series method to evaluate the impact of three key temporal breakpoints on CDI incidence rate was performed using the Poisson regression model. Results: A downward trend for cephalexin, ceftriaxone, clindamycin, gentamicin, macrolides, metronidazole, and penicillin sodium was identified. In contrast, an upward trend was recognized for amoxicillin, ceftazidime/avibactam, ertapenem, fluconazole, ketoconazole, levofloxacin, and tigecycline. Among the antimicrobials that showed a positive association between consumption and the incidence of CDI are clindamycin and cephalosporins after immediate consumption. Moreover, macrolides and metronidazole presented a positive correlation, in both immediate and delayed consumption. PPIs consumption did not show changes and was not associated with nosocomial CDI incidence. The interrupted time series analysis showed no changes at the breakpoints selected. Conclusions: Consumption of clindamycin, cephalosporins, and macrolides showed positive association with CDI, despite having a downtrend in consumption. Specific events, such as the COVID-19 pandemic and the implementation of ASP, have had no correlation with CDI. Further analysis is required in Latin America to advance our understanding of risk factors associated with CDI.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/10230/72772
http://dx.doi.org/10.3390/antibiotics14040350
url https://hdl.handle.net/10230/72772
http://dx.doi.org/10.3390/antibiotics14040350
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Antibiotics. 2025;14(4):350
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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