Association Between Neighbourhood-level Antibiotic Utilization and the Rate of Community-Associated C. difficile (CA-CDI) Infection: An Ecological Study
Year: 2026
Type: article
Abstract: Background Despite reductions in hospital-associated Clostridioides difficile infection (CDI) incidence in Canada and the United States, the incidence of community-associated CDI (CA-CDI) has remained high. We sought to investigate whether neighbourhood-level variation in antibiotic utilization is associated with CA-CDI. Method We conducted a neighbourhood-level ecological study across 1,520 neighbourhoods in Ontario, Canada. Residents aged ≥66 without hospitalization in the prior 30 days were eligible for inclusion from 2017 to 2023. Antibiotic utilization, CDI cases, and population were identified for each neighbourhood using comprehensive province-wide databases. CA-CDI rate was the outcome (incident cases of CA-CDI/10,000 person-years). Rate of antibiotic utilization (DOT per 1000 person-days) was the primary exposure. The rate-ratio (RR) of CA-CDI associated with increased antibiotic utilization was estimated using negative-binomial regression, adjusting for 8 demographic and health care covariates. We also evaluated risk based on low-, moderate-, and high-risk antibiotic strata based on published literature. Result We identified 19,757 CA-CDI cases. We observed substantial variation in antibiotic utilization across neighbourhoods (Median=21.1 DOT/1000 person-days; interquartile range [IQR], 16.7–25.6). After adjustments, we observed an association between overall antibiotic utilization (RR=1.13 per 10-point increase in DOT; 95% confidence interval [95%CI], 1.09–1.18). A gradient wherein higher risk antibiotic agents were more strongly associated with CA-CDI was apparent (Low-risk: RR=1.08; 95%CI, 1.01–1.15; Moderate-risk: RR=1.27; 95%CI, 1.15–1.39; High-risk: RR=1.73; 95%CI, 1.13–2.66). Discussion Neighbourhoods with higher antibiotic utilization, especially for moderate and high-risk antibiotics, have higher CA-CDI incidence. Reducing variability in neighbourhood antibiotic utilization could help reduce the burden of CDI.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciag661
Institutions: Ontario College of Art and Design, Sunnybrook Health Science Centre, Institute of Health Services and Policy Research, Public Health Ontario, Institute for Clinical Evaluative Sciences, Sunnybrook Hospital, Impact, McMaster University, Toronto East General Hospital, University of Toronto
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
OpenAlex ID: W7222876182
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