Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T20:06:31.781Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium difficile Infection Among Veterans Health Administration Patients

Published online by Cambridge University Press:  05 June 2015

Yinong Young-Xu ,
Jennifer L Kuntz ,
Dale N. Gerding ,
Julia Neily ,
Peter Mills ,
Erik R. Dubberke ,
Margaret A. Olsen ,
Ciarán P. Kelly  and
Cédric Mahé
Yinong Young-Xu*
Affiliation:
National Center for Patient Safety, Department of Veterans Affairs, White River Junction, Vermont, United States Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
Jennifer L Kuntz
Affiliation:
Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, United States
Dale N. Gerding
Affiliation:
Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois and Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
Julia Neily
Affiliation:
National Center for Patient Safety, Department of Veterans Affairs, White River Junction, Vermont, United States
Peter Mills
Affiliation:
National Center for Patient Safety, Department of Veterans Affairs, White River Junction, Vermont, United States Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
Erik R. Dubberke
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
Margaret A. Olsen
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
Ciarán P. Kelly
Affiliation:
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
Cédric Mahé
Affiliation:
Sanofi-Pasteur, Lyon, France
*
Address correspondence to Yinong Young-Xu, ScD, MA, MS, VAMC (10A4E), 215 North Main Street, White River Junction, VT, 05009 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To report on the prevalence and incidence of Clostridium difficile infection (CDI) from 2009 to 2013 among Veterans Healthcare Administration patients

DESIGN

A retrospective descriptive analysis of data extracted from a large electronic medical record (EMR) database

SETTING

Data were acquired from VHA healthcare records from 2009 to 2013 that included outpatient clinical visits, long-term care, and hospitalized care as well as pharmacy and laboratory information.

RESULTS

In 2009, there were 10,207 CDI episodes, and in 2013, there were 12,143 CDI episodes, an increase of 19.0%. The overall CDI rate increased by 8.4% from 193 episodes per 100,000 patient years in 2009 to 209 episodes per 100,000 patient years in 2013. Of the CDI episodes identified in 2009, 58% were identified during a hospitalization, and 42% were identified in an outpatient setting. In 2013, 44% of the CDI episodes were identified in an outpatient setting.

CONCLUSION

This is one of the largest studies that has utilized timely EMR data to describe the current CDI epidemiology at the VHA. Despite an aging population with greater burden of comorbidity than the general US population, our data show that VHA CDI rates stabilized between 2011 and 2013 following increases likely attributable to the introduction of the more sensitive nucleic acid amplification tests (NAATs). The findings in this report will help establish an accurate benchmark against which both current and future VA CDI prevention initiatives can be measured.

Infect. Control Hosp. Epidemiol. 2015;36(9):1038–1045

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 9 , September 2015 , pp. 1038 - 1045
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This work represents the opinions of the authors and does not necessarily represent the views of the Department of Veterans Affairs or the US government.

References

1. Rupnik, M, Wilcox, MH, Gerding, DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol 2009;7:526–536.Google Scholar
2. Koo, HL, Garey, KW, DuPont, HL. Future novel therapeutic agents for Clostridium difficile infection. Expert Opin Investig Drugs 2010;19:825–836.Google Scholar
3. Kelly, CP, LaMont, JT. Clostridium difficile—more difficult than ever. N Engl J Med 2008;359:1932–1940.Google Scholar
4. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the Healthcare System. Clin Infect Dis 2012;55:S88–S92.CrossRefGoogle ScholarPubMed
5. Centers for Disease Control and Prevention. QuickStats: rates of Clostridium difficile infection among hospitalized patients aged ≥65 years, by age group—National Hospital Discharge Survey, United States, 1996–2009. MMWR Morb Mortal Wkly 2011;60:1171.Google Scholar
6. Kyne, L, Warny, M, Qamar, A, Kelly, CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000;342:390.Google Scholar
7. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204.Google Scholar
8. Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992.Google Scholar
9. Armbruster, S, Goldkind, L. A 5-year retrospective review of experience with Clostridium difficile-associated diarrhea. Mil Med 2012;177:456–459.Google Scholar
10. Jump, RL, Olds, DM, Jury, LA, et al. Specialty care delivery: bringing infectious disease expertise to the residents of a Veterans Affairs long-term care facility. J Am Geriatr Soc 2013;61:782–787.Google Scholar
11. Bajaj, JS, Ratliff, SM, Heuman, DM, Lapane, KL. Proton pump inhibitors are associated with a high rate of serious infections in veterans with decompensated cirrhosis. Aliment Pharmacol Ther 2012;36:866–874.CrossRefGoogle ScholarPubMed
12. Huttner, B, Jones, M, Rubin, MA, et al. Double trouble: how big a problem is redundant anaerobic antibiotic coverage in Veterans Affairs medical centers? J Antimicrob Chemother 2012;67:1537–1539.Google Scholar
13. McFarland, LV, Clarridge, JE, Beneda, HW, Raugi, GJ. Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a Veterans Administration health care system. Clin Infect Dis 2007;45:1141–1151.Google Scholar
14. Donskey, CJ, Sunkesula, VC, Jencson, AL, et al. Utility of a commercial PCR assay and a clinical prediction rule for detection of toxigenic Clostridium difficile in asymptomatic carriers. J Clin Microbiol 2014;52:315–318.Google Scholar
15. Graber, CJ, Madaras-Kelly, K, Jones, MM, Neuhauser, MM, Goetz, MB. Unnecessary antimicrobial use in the context of Clostridium difficile infection: a call to arms for the Veterans Affairs Antimicrobial Stewardship Task Force. Infect Control Hosp Epidemiol 2013;34:651–653.Google Scholar
16. Balbale, SN, Johnson, S, Burns, SP, et al. Community-associated Clostridium difficile infection among veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2014;35:577–580.CrossRefGoogle ScholarPubMed
17. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol, 28:140–145.Google Scholar
18. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
19. Evans, ME. Clostridium difficile infections in Veterans Health Administration acute care facilities. Infect Control Hosp Epidemiol 2014;35:1037–1042.Google Scholar
20. Gould, CV, Edwards, JR, Cohen, J, et al. Effect of nucleic acid amplification testing on population-based incidence rates of Clostridium difficile infection. Clin Infect Dis 2013;57:1304–1307.CrossRefGoogle ScholarPubMed
21. Chitnis, AS, Holzbauer, SM, Belflower, RM, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 2013;173:1359–1367.Google Scholar
22. Goto, M, Ohl, ME, Schweizer, ML, Perencevich, EN. Accuracy of administrative code data for the surveillance of healthcare-associated infections: a systematic review and meta-analysis. Clin Infect Dis 2014; Mar 58:688–696.CrossRefGoogle ScholarPubMed
23. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.CrossRefGoogle ScholarPubMed
24. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar