Hospital Clostridium difficile infection (CDI) incidence as a risk factor for hospital-associated CDI

Abstract

Background Environmental risk factors for Clostridium difficile infections (CDIs) have been described at the room or unit level but not the hospital level. To understand the environmental risk factors for CDI, we investigated the association between institutional- and individual-level CDI. Methods We performed a retrospective cohort study using the Healthcare Cost and Utilization Project state inpatient databases for California (2005–2011). For each patient’s hospital stay, we calculated the hospital CDI incidence rate corresponding to the patient’s quarter of discharge, while excluding each patient’s own CDI status. Adjusting for patient and hospital characteristics, we ran a pooled logistic regression to determine individual CDI risk attributable to the hospital’s CDI rate. Results There were 10,329,988 patients (26,086 cases and 10,303,902 noncases) who were analyzed. We found that a percentage point increase in the CDI incidence rate a patient encountered increased the odds of CDI by a factor of 1.182. Conclusions As a point of comparison, a 1-percentage point increase in the CDI incidence rate that the patient encountered had roughly the same impact on their odds of acquiring CDI as a 55.8-day increase in their length of stay or a 60-year increase in age. Patients treated in hospitals with a higher CDI rate are more likely to acquire CDI.

Estimating the Attributable Disease Burden and Effects of Interhospital Patient Sharing on Clostridium difficile Infections

“…All of these hospital-level risk factors confirm previous findings at the individual level. 8,[14][15][16][17][18]27 Our method of estimating the burden of disease attributable to hospital transfers used a statistical model and a counterfactual-like approach. This approach was based on conditional expectations; we compared the expected number of CDI cases given that there is a network effect versus the expected number of CDI cases given that the network effect is negated.…”

“…24 Higher risks of CDI have also been reported in rooms where a previous occupant had a CDI 25,26 and in hospitals with higher CDI incidence. 27 The increased risk associated with environmental exposures could reflect a contaminated environment [25][26][27][28] or exposure to increased levels of antimicrobials beyond individual exposures. 29 Recent work has shown that hospital transfer rates have also been associated with CDI.…”

Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study

“…To our knowledge, this is the first study to estimate the impact of CDI environmental pressure on subsequent risk of HA-CDI after accounting for both antimicrobial use and antimicrobial stewardship activities [ 34 – 38 ]. In this study, CDI environmental pressure was defined as the ward-level prevalence of total CDI cases (both HA-CDI and CA-CDI) and CA-CDI cases in the preceding month and current month, respectively.…”

Spatiotemporal clustering of in-hospital Clostridioides difficile infection

“…In general, CDI pressure, the increasing risk of CDI acquisition with increasing numbers of CDI patients, has been documented at both the ward 11 and hospital levels. 12 More specifically, evidence for underlying environmental CDI contamination include reports of C. difficile spores on high-touch surfaces in healthcare settings, 13,14 patient skin, 15,16 and hands of healthcare workers. 17,18 In addition, C. difficile contamination increases in rooms occupied by patients with symptomatic CDI; thus, room assignments (eg, patients placed in a room with previous occupant who had CDI) are also associated with increased risk of CDI acquisition.…”