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Trends and Seasonality in Antibiotic Resistance Among Elderly Patients with Clostridium Difficile-Associated Disease
JAGAI, J. S., S. Paris, AND E. N. Naumova. Trends and Seasonality in Antibiotic Resistance Among Elderly Patients with Clostridium Difficile-Associated Disease. Presented at 43rd Annual Meeting of the Society for Epidemiologic (SER), Seattle, WA, June 23 - 26, 2010.
We evaluate differences in patterns between hospitalization rates of C. dijficile and percentage of C. dijficile with antibiotic resistance (AR) by gender, geographic distribution, annual trends, and seasonality.
In the US, over 300,000 cases of Clostridium dijficile-associated disease (CDAD) occur annually in hospitals or long-term care facilities and incidence has risen over the past two decades potentially due to increased antibiotic use. A primary risk factor for CDAD is previous antibiotic exposure therefore, temporal patterns in CDAD hospitalizations may be driven by pathogens for which antibiotics are prescribed. We evaluate differences in patterns between hospitalization rates of C. dijficile and percentage of C. dijficile with antibiotic resistance (AR) by gender, geographic distribution, annual trends, and seasonality. All 1,054,125 hospitalization records for the US elderly for C. difficile were abstracted from the Centers for Medicare and Medicaid Services MedPAR database for a l-l-year period (1991-2004). In the population over 65, hospitalization rates ofCDAD increased from 13.71 per 10,000 in 1993 to 45.18 per 10,000 in 2004. Of all cases 19,654 (1.86%) exhibited co-morbid AR. The overall number of AR cases increased and the percentage of cases demonstrated an increasing trend from 0.06% to 2.35% over the study period. As expected, the highest rate of hospitalizations was observed in the 85+ years old individuals (48.2 per 10,000 population vs. 11.9 in 65-74 y.o., and 26.0 in 75-84 y.o.). Counts were organized into weekly time series and the highest rates of CDAD were observed in mid-March (week 10) for all age groups. Cases of CDAD with AR did not show a clear seasonal pattern. These results suggest that C. dijficile and antibiotic resistance is a significant and growing concern in the elderly population and is associated with environmental characteristics that require further research.