BACKGROUND Associations between antimicrobial exposure in the community and community-associated Clostridioides difficile infection (CA-CDI) are well documented but associations with healthcare-associated CDI (HA-CDI) are less clear. This study estimates the association between antimicrobial prescribing in the community and HA-CDI. METHODS A matched case-control study was conducted by linking three national patient level datasets covering CDI cases, community prescriptions and hospitalizations. All validated cases of HA-CDI (August 2010 to July 2013) were extracted and up to three hospital-based controls were matched to each case on the basis of gender, age, hospital and date of admission. Conditional logistic regression was applied to estimate the association between antimicrobial prescribing in the community and HA-CDI. A sensitivity analysis was conducted to consider the impact of unmeasured hospital antimicrobial prescribing. RESULTS Nine-hundred and thirty unique cases of HA-CDI with onset in hospital and no hospital discharge in the 12 weeks prior to index admission were linked with 1810 matched controls. Individuals with prior prescription of any antimicrobial in the community had an odds ratio (OR) = 1.41 (95% confidence interval (CI) 1.13-1.75) for HA-CDI compared with those without. Individuals exposed to high-risk antimicrobials (cephalosporins, clindamycin, co-amoxiclav or fluoroquinolones) had an OR = 1.86 (95% CI: 1.33-2.59). After accounting for the likely impact of unmeasured hospital prescribing, the community exposure, particulary to high-risk antimicrobials, was still associated with elevated HA-CDI risk. CONCLUSIONS Community antimicrobial exposure is an independent risk factor for HA-CDI and should be considered as part of the risk assessment of patients developing diarrhoea in hospital.

中文翻译：

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社区抗菌药物暴露对医院发作的医疗相关艰难梭菌梭状芽胞杆菌感染风险的残留影响：使用国家相关数据进行的病例对照研究。

背景技术在社区中的抗菌素暴露与社区相关的艰难梭菌艰难梭菌感染（CA-CDI）之间的关联已有充分文献记载，但与医疗保健相关的CDI（HA-CDI）的关联尚不清楚。这项研究估计了社区抗菌药物处方与HA-CDI之间的关联。方法通过将涵盖CDI病例，社区处方和住院情况的三个国家级患者数据集进行链接，进行了匹配的病例对照研究。提取所有经过验证的HA-CDI病例（2010年8月至2013年7月），并根据性别，年龄，住院和入院日期对每个病例​​进行多达三个基于医院的对照匹配。应用条件logistic回归来估计社区抗菌药物处方与HA-CDI之间的关联。进行了敏感性分析，以考虑未经计量的医院抗菌药物处方的影响。结果入院前12周内有930例在医院内发病且无出院的HA-CDI病例与1810例匹配的对照组相关。与未使用抗生素的社区相比，先前在社区中使用任何抗菌药物的个体的HA-CDI的优势比（OR）= 1.41（95％置信区间（CI）1.13-1.75）。暴露于高危抗微生物药物（头孢菌素，克林霉素，共阿莫西拉夫或氟喹诺酮类）的个体的OR值为1.86（95％CI：1.33-2.59）。在考虑了未经计量的医院开处方可能产生的影响之后，社区暴露，尤其是高危抗菌药物的暴露，仍然与高HA-CDI风险相关。