{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T08:40:45Z","timestamp":1790239245981,"version":"4.1.0"},"reference-count":34,"publisher":"Microbiology Society","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,6,1]]},"abstract":"<jats:p>The first Dutch outbreak due to <jats:italic>Clostridium difficile<\/jats:italic> ribotype 027 was observed in mid-2005; by the end of that year, eight hospitals were affected. To study the relationship between hospital-wide antibiotic use and the incidence of 027-linked <jats:italic>C. difficile<\/jats:italic>-associated disease (CDAD) three study groups were made: group A, all eight hospitals with an 027-associated epidemic; group B, five of a total of six hospitals with occasional 027 cases, without an increase in CDAD; and group C, ten randomly selected hospitals with no reported 027 epidemics or isolated 027 cases. Quarterly data on CDAD incidences, hygiene measures and the use of fluoroquinolones, second- and third-generation cephalosporins, extended-spectrum penicillins, penicillins with beta-lactamase inhibitors, carbapenems, lincomycins and macrolides were collected for 2004 and 2005, and divided into pre-epidemic and epidemic periods. Using a multilevel Poisson regression analysis, CDAD incidence was linked to antibiotic use in the previous quarter and to certain hygiene measures. In the pre-epidemic period, the total use of the studied antibiotics was comparable between affected and unaffected hospitals. Higher use of second-generation cephalosporins, macrolides and all of the studied antibiotics were independently associated with a small increase in CDAD incidence [relative risk (95\u200a% confidence interval): 1.14 per increase of 100 defined daily doses per 10\u200a000 bed days (1.06\u20131.23), 1.10 (1.01\u20131.19) and 1.02 (1.01\u20131.03), respectively]. However the effect was too small to predict which hospitals might be more prone to 027-associated outbreaks.<\/jats:p>","DOI":"10.1099\/jmm.0.47711-0","type":"journal-article","created":{"date-parts":[[2008,5,14]],"date-time":"2008-05-14T17:28:49Z","timestamp":1210786129000},"page":"709-716","source":"Crossref","is-referenced-by-count":20,"title":["Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027"],"prefix":"10.1099","volume":"57","author":[{"given":"T. I. 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