Seasonal Variations in Clostridium difficile Infections Are Associated with Influenza and Respiratory Syncytial Virus Activity Independently of Antibiotic Prescriptions: a Time Series Analysis in Québec, Canada

• Published in: Antimicrobial Agents and Chemotherapy Vol. 56; no. 2; pp. 639 - 646
• Main Authors: Gilca, Rodica, Fortin, Élise, Frenette, Charles, Longtin, Yves, Gourdeau, Marie
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.02.2012
• Subjects: Anti-Bacterial Agents; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Clostridium difficile; Clostridium difficile - drug effects; Clostridium difficile - isolation & purification; Clostridium Infections; Clostridium Infections - complications; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Community-Acquired Infections - drug therapy; diarrhea; disease incidence; disease outbreaks; Drug Resistance, Bacterial; Epidemiology and Surveillance; fluoroquinolones; Fluoroquinolones - pharmacology; Fluoroquinolones - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; Hospitalization - statistics & numerical data; hospitals; Human viral diseases; Humans; Incidence; Infectious diseases; influenza; Influenza, Human; Influenza, Human - complications; Influenza, Human - epidemiology; Influenza, Human - virology; macrolides; Macrolides - pharmacology; Macrolides - therapeutic use; Medical sciences; morbidity; Orthomyxoviridae; Orthomyxoviridae - isolation & purification; Other diseases. Semiology; Pharmacology. Drug treatments; Population Surveillance - methods; Quebec - epidemiology; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus Infections - complications; Respiratory Syncytial Virus Infections - epidemiology; Respiratory Syncytial Virus Infections - virology; Respiratory Syncytial Virus, Human - isolation & purification; Respiratory Tract Infections - drug therapy; seasonal variation; Seasons; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; time series analysis; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; viruses; winter; Quebec; Canada; North America; America; Human respiratory syncytial virus; Pneumovirinae; Clostridium difficile; Time series; Clostridiales; Diarrhea; Biological activity; Paramyxoviridae; Virus; Infection; Respiratory tract; Mononegavirales; Medical prescription; Seasonal variation; Viral disease; Influenza; Clostridiaceae; Bacteria; Digestive diseases; Intestinal disease; Pneumovirus; Antibacterial agent; Time analysis
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.05411-11

Seasonal variations in Clostridium difficile-associated diarrhea (CDAD), with a higher incidence occurring during winter months, have been reported. Although winter epidemics of respiratory viruses may be temporally associated with an increase in CDAD morbidity, we hypothesized that this association is mainly due to increased antibiotic use for respiratory infections. The objective of this study was to evaluate the effect of the two most frequent respiratory viruses (influenza virus and respiratory syncytial virus [RSV]) and antibiotics prescribed for respiratory infections (fluoroquinolones and macrolides) on the CDAD incidence in hospitals in the province of Québec, Canada. A multivariable Box-Jenkins transfer function model was built to relate monthly CDAD incidence to the monthly percentage of positive tests for influenza virus and RSV and monthly fluoroquinolone and macrolide prescriptions over a 4-year period (January 2005 to December 2008). Analysis showed that temporal variations in CDAD incidence followed temporal variations for influenza virus (P = 0.043), RSV (P = 0.004), and macrolide prescription (P = 0.05) time series with an average delay of 1 month and fluoroquinolone prescription time series with an average delay of 2 months (P = 0.01). We conclude that influenza virus and RSV circulation is independently associated with CDAD incidence after controlling for fluoroquinolone and macrolide use. This association was observed at an aggregated level and may be indicative of other phenomena occurring during wintertime.