{"id":23589,"date":"2026-04-20T14:06:10","date_gmt":"2026-04-20T18:06:10","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=23589"},"modified":"2026-04-23T14:09:49","modified_gmt":"2026-04-23T18:09:49","slug":"cessation-of-amoxicillin-clavulanate-selective-reporting-and-association-with-antibiotic-prescribing-and-c-difficile-infection-in-ontario-canada-2017-2024","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/cessation-of-amoxicillin-clavulanate-selective-reporting-and-association-with-antibiotic-prescribing-and-c-difficile-infection-in-ontario-canada-2017-2024\/","title":{"rendered":"Cessation of amoxicillin-clavulanate selective reporting and association with antibiotic prescribing and C. difficile infection in Ontario, Canada, 2017-2024: an ecological study"},"content":{"rendered":"<p><strong>Objectives<\/strong> \u2014 To discourage unnecessary use of amoxicillin-clavulanate (a broader-spectrum antibiotic with high Clostridioides difficile infection (CDI) risk), selective reporting is used to suppress susceptibility results when the isolate is susceptible to narrower-spectrum antibiotics like amoxicillin. In Ontario, Canada, surveillance data revealed a rapid increase in amoxicillin-clavulanate susceptibility reporting in December 2021, consistent with a cessation of selective reporting in some community laboratories. Our objective was to examine whether increased amoxicillin-clavulanate susceptibility reporting among amoxicillin-susceptible urinary isolates was associated with increased prescribing of amoxicillin-clavulanate and community-associated CDI (CA-CDI) at a population level.<\/p>\n<p><strong>Methods<\/strong> \u2014 We conducted an ecological longitudinal study of Ontario residents from January 2017 to June 2024, using monthly province-wide aggregated data. The primary exposure was monthly percentage of amoxicillin-clavulanate reporting among amoxicillin-susceptible Escherichia coli and Proteus mirabilis isolates. Outcomes included monthly amoxicillin-clavulanate prescribing rates and CA-CDI incidence, while prescribing of amoxicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, ciprofloxacin, and first-generation cephalosporins served as comparators. Analyses used negative binomial regression stratified by age and sex, adjusted for respiratory virus activity.<\/p>\n<p><strong>Results<\/strong> \u2014 Following an increase in amoxicillin-clavulanate susceptibility reporting from 4.1% (Jan 2017 \u2013 Nov 2021) to 56.7% (Dec 2021 \u2013 Jun 2024) among amoxicillin-susceptible isolates, amoxicillin-clavulanate prescribing increased (Incidence Rate Ratio (IRR): 1.29, 95%CI: 1.17-1.43), while comparator antibiotic prescribing remained stable (amoxicillin IRR: 0.97, 95%CI: 0.87-1.09). Compared to amoxicillin, amoxicillin-clavulanate prescribing increased by 36% (IRR: 1.36, 95%CI: 1.23-1.51). The change in reporting was associated with 459 (95%CI: 336-585) modelled excess cases of CA-CDI from Dec 2021\u2013Jun 2024, compared with the projected CA-CDI incidence if there had been no change in amoxicillin-clavulanate reporting.<\/p>\n<p><strong>Conclusion<\/strong> \u2014 Our study suggests that reporting amoxicillin-clavulanate susceptibility among amoxicillin-susceptible urinary isolates is associated with increased amoxicillin-clavulanate prescribing and higher CA-CDI rates based on model-derived estimates, highlighting the impact of selective antibiotic susceptibility reporting by microbiology laboratories on patient outcomes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objectives \u2014 To discourage unnecessary use of amoxicillin-clavulanate (a broader-spectrum antibiotic with high Clostridioides difficile infection (CDI) risk), selective reporting is used to suppress susceptibility results when the isolate is susceptible to narrower-spectrum antibiotics like amoxicillin. In Ontario, Canada, surveillance data revealed a rapid increase in amoxicillin-clavulanate susceptibility reporting in December 2021, consistent with a [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[39,56,35],"migration-helper-qa-sample-set":[],"class_list":["post-23589","journal_article","type-journal_article","status-publish","hentry","topic-infectious-diseases","topic-pharmacoepidemiology-and-drug-safety","topic-public-health"],"acf":{"citation":"Wong MK, Daneman N, Langford BJ, Leung V, Schwartz KL, Almohri H, Goneau LW, Brown KA. <em>Clin Microbiol Infect<\/em>. 2026; S1198-743X(26): 00199-0. Epub 2026 Apr 20.","source_url":"https:\/\/doi.org\/10.1016\/j.cmi.2026.04.015","ices_scientist":[1215,1347,1181],"site":[6733],"research_program":[6745],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Cessation of amoxicillin-clavulanate selective reporting and association with antibiotic prescribing and C. difficile infection in Ontario, Canada, 2017-2024: an ecological study<\/title>\n<meta name=\"description\" content=\"Objectives \u2014 To discourage unnecessary use of amoxicillin-clavulanate (a broader-spectrum antibiotic with high Clostridioides difficile infection (CDI)\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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