ArticleOpen forum infectious diseases2015
Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection.
Article in Open forum infectious diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.
- Epidemiologic profile of community-acquiredEpidemiology and infection · 2025Pooled it
- Article
- Practical and clinical significance of the pharmacist-led antimicrobial stewardship.Journal of pharmaceutical health care and sciences · 2026Review
- Every prescription counts: rethinking outpatient antibiotic stewardship in Abu Dhabi, United Arab Emirates.Frontiers in public health · 2026Article
- Comparison of the LuminexJournal of medical microbiology · 2025Article
- Utilization of broad- versus narrow-spectrum antibiotics for the treatment of outpatient community-acquired pneumonia among adults in the United States.Pharmacoepidemiology and drug safety · 2024Article
- Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures.JAMA network open · 2022Article
- Prophylactic antimicrobials may not be needed to prevent surgical site infection after skin biopsy: a retrospective study.Antimicrobial resistance and infection control · 2022Article
- Concordance of antibiotic prescribing with the American Dental Association acute oral infection guidelines within Veterans' Affairs (VA) dentistry.Infection control and hospital epidemiology · 2021Article
- Antimicrobial stewardship and infection prevention interventions targeting healthcare-associatedBMJ open · 2021Article
- Nurse practitioners as antibiotic stewards: Examining prescribing patterns and perceptions.American journal of infection control · 2021Article
- Perceptions of the Benefits and Risks of Antibiotics Among Adult Patients and Parents With High Antibiotic Utilization.Open forum infectious diseases · 2020Article
- Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection.JAMA network open · 2020Article
- Antimicrobial stewardship in the primary care setting: from dream to reality?BMC family practice · 2020Article
- Use of Antibiotics for Dermatologic Procedures From 2008 to 2016.JAMA dermatology · 2019Article
- Trends in Oral Antibiotic Prescription in Dermatology, 2008 to 2016.JAMA dermatology · 2019Article
- Successful Implementation of an Antibiotic Stewardship Program in an Academic Dental Practice.Open forum infectious diseases · 2019Article
- Article
Corrections and comments
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Authors and funding
15 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background. Antibiotic use predisposes patients to Clostridium difficile infections (CDI), and approximately 32% of these infections are community-associated (CA) CDI. The population-level impact of antibiotic use on adult CA-CDI rates is not well described. Methods. We used 2011 active population- and laboratory-based surveillance data from 9 US geographic locations to identify adult CA-CDI cases, defined as C difficile-positive stool specimens (by toxin or molecular assay) collected from outpatients or from patients ≤3 days after hospital admission. All patients were surveillance area residents and aged ≥20 years with no positive test ≤8 weeks prior and no overnight stay in a healthcare facility ≤12 weeks prior. Outpatient oral antibiotic prescriptions dispensed in 2010 were obtained from the IMS Health Xponent database. Regression models examined the association between outpatient antibiotic prescribing and adult CA-CDI rates. Methods. Healthcare providers prescribed 5.2 million courses of antibiotics among adults in the surveillance population in 2010, for an average of 0.73 per person. Across surveillance sites, antibiotic prescription rates (0.50-0.88 prescriptions per capita) and unadjusted CA-CDI rates (40.7-139.3 cases per 100 000 persons) varied. In regression modeling, reducing antibiotic prescribing rates by 10% among persons ≥20 years old was associated with a 17% (95% confidence interval, 6.0%-26.3%; P = .032) decrease in CA-CDI rates after adjusting for age, gender, race, and type of diagnostic assay. Reductions in prescribing penicillins and amoxicillin/clavulanic acid were associated with the greatest decreases in CA-CDI rates. Conclusions and Relevance. Community-associated CDI prevention should include reducing unnecessary outpatient antibiotic use. A modest reduction of 10% in outpatient antibiotic prescribing can have a disproportionate impact on reducing CA-CDI rates.
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