Increasing contribution of dental antibiotic prescribing to community-acquired Clostridioides difficile infection: a 9-year retrospective cohort study.

PURPOSE: Community-acquired Clostridioides difficile infection (CA-CDI) is increasingly recognized outside healthcare settings, yet the contribution of dental antibiotic prescribing remains poorly characterized. This study compared patients with CA-CDI following antibiotics prescribed by dental practitioners versus family physicians.

METHODS

We conducted a retrospective cohort study at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia, including adults with a first episode of confirmed CA-CDI following outpatient antibiotic exposure between 2011 and 2019. Characteristics were compared by prescriber.

RESULTS

Among 666 patients with CA-CDI, 190 (28.5%) had received antibiotics from dental practitioners and 476 (71.5%) from family physicians. Dental-associated CA-CDI increased significantly over time (13.1% in 2011 to 31.1% in 2019; p = 0.003). Dental patients had a lower comorbidity burden, with less frequent diabetes, chronic obstructive pulmonary disease, and proton pump inhibitor use. Amoxicillin-clavulanate was the most frequently prescribed antibiotic overall; clindamycin was more common among dental patients (39.9% vs. 11.9%), 79.7% of whom had no penicillin allergy. Severity and treatment duration were similar between groups.

CONCLUSION

Dental antibiotic prescribing emerged as an increasingly important contributor to CA-CDI, associated with higher clindamycin use despite a lower burden of traditional risk factors, highlighting the need to strengthen antimicrobial stewardship in dental practice.