Consumption of Antibiotics and Epidemiology of Clostridioides difficile in the European Union in 2016—Opportunity for Practical Application of Aggregate ECDC Data

Abstract

Background: The most important pathomechanism of Clostridioides difficile infections (CDI) is post-antibiotic intestinal dysbiosis. CDI affects both ambulatory and hospital patients. Aim: The objective of the study was to analyze the possibility of utilizing databases from the European Centre for Disease Prevention and Control subject to surveillance for the purpose of identifying areas that require intervention with respect to public health. Methods: The analysis encompassed data concerning CDI incidence and antibiotic consumption expressed as defined daily doses (DDD) and quality indicators for antimicrobial-consumption involving both ambulatory and hospital patients in 2016. Results: In 2016, in the European Union countries, total antibiotic consumption in hospital and outpatient treatment amounted to 20.4 DDD (SD 7.89, range 11.04–39.69); in ambulatory treatment using average of ten times more antibiotics than hospitals. In total, 44.9% of antibiotics used in outpatient procedures were broad-spectrum antibiotics. We have found a significant relationship between the quality of antibiotics and their consumption: The more broad-spectrum antibiotics prescribed, the higher the sales of antibiotics both in the community sector and in total. CDI incidence did not statistically significantly correlate with the remaining factors analyzed on a country-wide level. Conclusion: Antibiotic consumption and the CDI incidence may depend on many national variables associated with local systems of healthcare organization and financing. Their interpretation in international comparisons does not give clear-cut answers and requires caution.