Utilizing the antibiotic spectrum index to assess hospital-onset Clostridioides difficile infection in treating adults with community-onset bloodstream infections.

BACKGROUND

Antimicrobial therapy is the management cornerstone of patients with bloodstream infections (BSIs). We aimed to investigate the application of an antibiotic spectrum index (ASI) to assess hospital-onset Clostridioides difficile infection (hCDI) when treating individuals with BSIs.

METHODS

In a retrospective multicenter cohort consisted of treatment-naïve and hospitalized adults experiencing community-onset BSIs, the association of ASIs and hCDI was recognized after adjusting for the independent predictors of hCDI.

RESULTS

Of the total 2,966 patients, each day of prolonged antimicrobial therapy was associated with an average increase of 11% for the likelihood of hCDI; each additional 30 units of total ASIs was linked to an average increase of 146%; and each additional unit of daily ASIs was associated with an average increase of 22%. Notably, the total ASI demonstrated superior performance in predicting hCDI, as reflected by the area under the receiver operating characteristic curve (AUROC = 0.971), compared with the total duration of antimicrobial administration (AUROC = 0.956).

CONCLUSIONS

The ASI metrics applied to assess hCDI episodes following the initiation of antimicrobial therapy in treating patients with community-onset BSIs proved effective. Accordingly, incorporating ASI-based assessments into antimicrobial stewardship programs might serve as a practical approach to mitigate hCDI risk.