{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:14:31Z","timestamp":1787602471105,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T00:00:00Z","timestamp":1661904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Defense of the Republic of Serbia","award":["MF\/VMA\/02\/20-22"],"award-info":[{"award-number":["MF\/VMA\/02\/20-22"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>This ecological study is the largest to date examining the association between rates of antibiotic use (AU) and hospital-onset (HO) Clostridioides difficile infection (CDI) in a tertiary university hospital in Serbia. There was no clear trend in the incidence of HO-CDI over time. Total utilization of antibacterials for systemic use increased from 38.57 DDD\/100 bed-days (BD) in 2011 to 56.39 DDD\/100 BD in 2021. The most commonly used antibiotics were third-generation cephalosporins, especially ceftriaxone, with maximum consumption in 2021 (19.14 DDD\/100 BD). The share of the Access group in the total utilization of antibiotics ranged from 29.95% to 42.96% during the observed period. The utilization of the Reserve group of antibiotics indicated a statistically significant increasing trend (p = 0.034). A statistically significant difference in the consumption of medium-risk antibiotics from 2011 to 2021 was shown for penicillins and a combination of sulfamethoxazole and trimethoprim. The consumption of cefotaxime showed a statistically significant negative association with the rate of HO-CDI (r = \u22120.647; p = 0.031). Ampicillin and the combination of amoxicilline with clavulanic acid have shown a negative statistically significant correlation with the ID of HO-CDI (r = \u22120.773 and r = \u22120.821, respectively). Moreover, there was a statistically significant negative correlation between consumption of \u201cmedium-risk antibiotics\u201d and the rate of HO-CDI (r = \u22120.677). The next challenging step for the hospital multidisciplinary team for antimicrobials is to modify the antibiotic list according to the Access, Watch, and Reserve classification, in such a way that at least 60% of the AU should be from the Access group, according to the World Health Organization recommendation.<\/jats:p>","DOI":"10.3390\/antibiotics11091178","type":"journal-article","created":{"date-parts":[[2022,8,31]],"date-time":"2022-08-31T23:53:21Z","timestamp":1661990001000},"page":"1178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Association between Antibiotic Use and Hospital-Onset Clostridioides difficile Infection in University Tertiary Hospital in Serbia, 2011\u20132021: An Ecological Analysis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4187-7584","authenticated-orcid":false,"given":"Aneta","family":"Peri\u0107","sequence":"first","affiliation":[{"name":"Department for Pharmacy, Military Medical Academy, 11000 Belgrade, Serbia"},{"name":"Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5122-8094","authenticated-orcid":false,"given":"Nemanja","family":"Ran\u010di\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia"},{"name":"Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktorija","family":"Dragojevi\u0107-Simi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia"},{"name":"Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4830-6917","authenticated-orcid":false,"given":"Bojana","family":"Milenkovi\u0107","sequence":"additional","affiliation":[{"name":"Department for Pharmacy, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7047-0428","authenticated-orcid":false,"given":"Nenad","family":"Ljubenovi\u0107","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojan","family":"Rakonjac","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesna","family":"Begovi\u0107-Kupre\u0161anin","sequence":"additional","affiliation":[{"name":"Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia"},{"name":"Clinic for Infectious and Tropic Diseases, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2830-0673","authenticated-orcid":false,"given":"Vesna","family":"\u0160uljagi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, Military Medical Academy, University of Defence, 11000 Belgrade, Serbia"},{"name":"Department of Healthcare-Related Infection Control, Military Medical Academy, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1093\/cid\/ciaa124","article-title":"Antibiotic Prescribing Choices and Their Comparative C. 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