{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:06:16Z","timestamp":1760058376824,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Exposure to antimicrobials and Proton Pump Inhibitors (PPIs) are modifiable risk factors for nosocomial Clostridiodes difficile infection (CDI). We investigated the association between these agents and nosocomial CDI over five years. Methods: Nosocomial CDI from January 2017 to December 2021 were included. Consumption trends were analyzed using a simple linear regression model. A correlation analysis was performed using Spearman\u2019s test in two ways: without a time interval and with 1-month interval matching. An interrupted time-series method to evaluate the impact of three key temporal breakpoints on CDI incidence rate was performed using the Poisson regression model. Results: A downward trend for cephalexin, ceftriaxone, clindamycin, gentamicin, macrolides, metronidazole, and penicillin sodium was identified. In contrast, an upward trend was recognized for amoxicillin, ceftazidime\/avibactam, ertapenem, fluconazole, ketoconazole, levofloxacin, and tigecycline. Among the antimicrobials that showed a positive association between consumption and the incidence of CDI are clindamycin and cephalosporins after immediate consumption. Moreover, macrolides and metronidazole presented a positive correlation, in both immediate and delayed consumption. PPIs consumption did not show changes and was not associated with nosocomial CDI incidence. The interrupted time series analysis showed no changes at the breakpoints selected. Conclusions: Consumption of clindamycin, cephalosporins, and macrolides showed positive association with CDI, despite having a downtrend in consumption. Specific events, such as the COVID-19 pandemic and the implementation of ASP, have had no correlation with CDI. Further analysis is required in Latin America to advance our understanding of risk factors associated with CDI.<\/jats:p>","DOI":"10.3390\/antibiotics14040350","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T13:36:49Z","timestamp":1743169009000},"page":"350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Antimicrobials and Pump Proton Inhibitors Consumption with the Incidence of Nosocomial Clostridiodes difficile Infection in High Complexity Hospitals in Costa Rica"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3186-4619","authenticated-orcid":false,"given":"Cristina","family":"Fern\u00e1ndez-Barrantes","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Barcelona, Spain"},{"name":"Department of Pharmacy, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jos\u00e9 10103, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6633-771X","authenticated-orcid":false,"given":"Allan","family":"Ramos-Esquivel","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Costa Rica, San Jos\u00e9 11501, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Esteban","family":"Hern\u00e1ndez-Soto","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, University of Costa Rica, San Jos\u00e9 11501, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5337-1030","authenticated-orcid":false,"given":"Manuel","family":"Ram\u00edrez-Cardoce","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jos\u00e9 10103, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8662-9422","authenticated-orcid":false,"given":"Luis David","family":"Garro-Zamora","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hopital M\u00e9xico, Caja Costarricense de Seguro Social, San Jos\u00e9 10107, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8441-2309","authenticated-orcid":false,"given":"Jos\u00e9 Castro","family":"Cordero","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Hospital M\u00e9xico, Caja Costarricense de Seguro Social, San Jos\u00e9 10107, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8428-1836","authenticated-orcid":false,"given":"Santiago","family":"Grau","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s10096-019-03539-6","article-title":"Clostridium difficile infection: Review","volume":"38","author":"Czepiel","year":"2019","journal-title":"Eur. 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