Hospital Transfer Network Structure as a Risk Factor for <i>Clostridium difficile</i> Infection

Simmering, Jacob E.; Polgreen, Linnea A.; Campbell, David R.; Cavanaugh, Joseph E.; Polgreen, Philip M.

doi:10.1017/ice.2015.130

Cited by 53 publications

(37 citation statements)

References 36 publications

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“…This suggests that MDR carriage is rare in the community, but MDR ESBL K. pneumoniae were occasionally acquired in the referring hospital prior to transfer to CH (ESBL GI carriage prevalence 1.7%, ESBL infection incidence 0.31%). These findings are likely generalisable to other hospital referral networks and highlight the benefits of exploring transmission at a multi-facility level [34,35]. However, larger studies will be needed to confirm the importance of referral networks for transmission of ESBL organisms, as has been demonstrated for MRSA and Clostridium difficile [34,35] , and to explore specific risk factors and the relevance to healthcare-associated infections.…”

Section: This Study Employed Illumina Short-read Wgs To Identify Highmentioning

confidence: 64%

Antimicrobial resistant Klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

Gorrie

Mirčeta

Wick

et al. 2017

Preprint

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Summary:Patients' own gut microbiota were the major source of K. pneumoniae, but extended-spectrum beta-lactamase strains were acquired in the referring hospital. This highlights the potential for rectal screening, and the importance of the wider hospital network, for local risk management.. CC-BY 4.0 International license It is made available under a (which was not peer-reviewed) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.The copyright holder for this preprint . http://dx.doi.org/10.1101/218461 doi: bioRxiv preprint first posted online Nov. 13, 2017; 2 Abstract Background. Klebsiella pneumoniae is a leading cause of extendedspectrum beta-lactamase (ESBL) producing hospital-associated infections, for which elderly patients are at increased risk.

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Section: This Study Employed Illumina Short-read Wgs To Identify Highmentioning

confidence: 64%

Antimicrobial resistant Klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

Gorrie

Mirčeta

Wick

et al. 2017

Preprint

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“…Previous studies have shown that use of antibiotics impacts individual risk for CDI when use of antibiotics is evaluated at the ward level, or even at the broader level of the hospital or the regional network. 3–6,22 Our study may be the most direct example to date of the potential effect of antibiotics on patients who do not themselves receive the antibiotics. In patients colonized by C. difficile , antibiotics may promote C. difficile proliferation and the number of C. difficile spores that are shed into the local environment.…”

Section: Discussionmentioning

confidence: 93%

Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

et al. 2016

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lostridium difficile infection (CDI) is the most common cause of diarrhea in the hospital and is responsible for an estimated 27 000 deaths annually in the United States. 1 Clostridium difficile infection occurs when there is a susceptible host and sufficient exposure to the organism. Many factors may increase host susceptibility to CDI, but the most crucial host-related risk factor is exposure to antibiotics. 2 Antibiotics are a risk factor for CDI not only when they are assessed at the level of the individual patient but also when they are assessed at the level of the hospital ward, 3,4 the level of the institution, 5 and the regional level. 6 Exposure to C difficile is common in the hospital because C difficile spores are capable of persisting in the environment for months. 7 High counts of C difficile spores can be detected in the stool of infected or colonized individuals, and C difficile can be readily cultured from the beds, bed rails, floors, and walls of hospital rooms where prior occupants have had CDI. 8,9 When individuals enter a new environment, they rapidly acquire C difficile as well as the other microorganisms that are present. 10 When one hospital roommate has CDI, patients who share that room are at increased risk for CDI. 11 Furthermore, when the previous occupant of a given hospital room has CDI, the subsequent patient in that room is at increased risk for CDI. 12 It is uncertain how antibiotics or other CDI risk factors might act on one patient to increase risk for CDI in a subsequent patient who shares the same hospital environment. We examined whether receipt of antibiotics by prior occupants of OBJECTIVE To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed. DESIGN, SETTING, AND PARTICIPANTSThis is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours. MAIN OUTCOMES AND MEASURESThe primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported. RESULTS Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P < .01). This relationship remained unchanged after adjusting for factors known to influence risk for CDI including receipt of antibiotics by the subsequent patient (adjusted hazard ratio [aHR...

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“…In addition, CDI rates may be dependent upon connections with other hospitals via patient transfers that we are unable to observe in this analysis. 38 Future investigations should focus on analyzing potentially causative factors driving the relationship between CDI rates and LOS in patients without CDI. For example, the additional isolation rooms needed for hospitals with a higher CDI incidence may result in ineffective transitions of care or misallocation of staffing resources.…”

Section: Discussionmentioning

confidence: 99%

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection

Polgreen

Cavanaugh

Polgreen

2016

Infect. Control Hosp. Epidemiol.

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Background Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS. Objective To describe the relationship between hospital CDI incidence and the LOS of patients without CDI. Design Retrospective cohort analysis. Methods We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age). Setting Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009–2011. Patients The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals. Results Inpatient LOS was significantly longer (P < .001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day’s stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS. Conclusion CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.

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Hospital Transfer Network Structure as a Risk Factor for Clostridium difficile Infection

Cited by 53 publications

References 36 publications

Antimicrobial resistant Klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

Antimicrobial resistant Klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection

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