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Antibiotics
Volume 14
Issue 4
10.3390/antibiotics14040350
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Article

Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica

by
Cristina Fernández-Barrantes
1,2,
Allan Ramos-Esquivel
3,
Luis Esteban Hernández-Soto
4,
Manuel Ramírez-Cardoce
5,
Luis David Garro-Zamora
6,
José Castro Cordero
7 and
Santiago Grau
8,*
1
Department of Pharmacology, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
2
Department of Pharmacy, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José 10103, Costa Rica
3
School of Medicine, University of Costa Rica, San José 11501, Costa Rica
4
Faculty of Pharmacy, University of Costa Rica, San José 11501, Costa Rica
5
Infectious Diseases Unit, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José 10103, Costa Rica
6
Department of Pharmacy, Hopital México, Caja Costarricense de Seguro Social, San José 10107, Costa Rica
7
Infectious Diseases Unit, Hospital México, Caja Costarricense de Seguro Social, San José 10107, Costa Rica
8
Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
*
Author to whom correspondence should be addressed.
Antibiotics 2025, 14(4), 350; https://doi.org/10.3390/antibiotics14040350
Submission received: 8 March 2025 / Revised: 25 March 2025 / Accepted: 25 March 2025 / Published: 28 March 2025
(This article belongs to the Special Issue Antimicrobial Prescribing, Population Use and Resistance, Impact in Global Health, 2nd Edition)
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Abstract

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.
Keywords: Clostridiodes difficile infection; antimicrobial consumption; pump proton inhibitors consumption; defined daily doses; antibiotic prescription Clostridiodes difficile infection; antimicrobial consumption; pump proton inhibitors consumption; defined daily doses; antibiotic prescription

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MDPI and ACS Style

Fernández-Barrantes, C.; Ramos-Esquivel, A.; Hernández-Soto, L.E.; Ramírez-Cardoce, M.; Garro-Zamora, L.D.; Cordero, J.C.; Grau, S. Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica. Antibiotics 2025, 14, 350. https://doi.org/10.3390/antibiotics14040350

AMA Style

Fernández-Barrantes C, Ramos-Esquivel A, Hernández-Soto LE, Ramírez-Cardoce M, Garro-Zamora LD, Cordero JC, Grau S. Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica. Antibiotics. 2025; 14(4):350. https://doi.org/10.3390/antibiotics14040350

Chicago/Turabian Style

Fernández-Barrantes, Cristina, Allan Ramos-Esquivel, Luis Esteban Hernández-Soto, Manuel Ramírez-Cardoce, Luis David Garro-Zamora, José Castro Cordero, and Santiago Grau. 2025. "Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica" Antibiotics 14, no. 4: 350. https://doi.org/10.3390/antibiotics14040350

APA Style

Fernández-Barrantes, C., Ramos-Esquivel, A., Hernández-Soto, L. E., Ramírez-Cardoce, M., Garro-Zamora, L. D., Cordero, J. C., & Grau, S. (2025). Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica. Antibiotics, 14(4), 350. https://doi.org/10.3390/antibiotics14040350

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