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Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis

Published online by Cambridge University Press:  29 May 2020

Jiyoun Song Open the ORCID record for Jiyoun Song [Opens in a new window] ,
Bevin Cohen ,
Philip Zachariah ,
Jianfang Liu  and
Elaine L. Larson
Jiyoun Song*
Affiliation:
Columbia University School of Nursing, New York City, New York
Bevin Cohen
Affiliation:
Columbia University School of Nursing, New York City, New York
Philip Zachariah
Affiliation:
Department of Pediatrics, Columbia University Irving Medical Center, New York, New York Department of Infection Prevention & Control, NewYork-Presbyterian Hospital, New York, New York
Jianfang Liu
Affiliation:
Columbia University School of Nursing, New York City, New York
Elaine L. Larson
Affiliation:
Columbia University School of Nursing, New York City, New York Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
*
Author for correspondence: Jiyoun Song, E-mail: js4753@cumc.columbia.edu
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Abstract

Objective:

Given recent changes in the epidemiology of Clostridioides difficile infection (CDI) and prevention efforts, we investigated temporal changes over a period of 11 years (2006–2016) in incidence and risk factors for CDI.

Design:

Retrospective matched case-control study.

Setting/Patients:

Pediatric and adult inpatients (n = 694,849) discharged from 3 hospitals (tertiary and quaternary care, community, and pediatric) in a large, academic health center in New York City.

Methods:

Risk factors were identified in cases and controls matched by length of stay at a ratio of 1:4. A Cochran–Armitage or Mann-Kendall test was used to investigate trends of incidence and risk factors.

Results:

Of 694,849 inpatients, 6,038 (0.87%) had CDI: 44% of these cases were hospital acquired (HA-CDI) and 56% were community acquired (CA-CDI). We observed temporal downward trends in HA-CDI (−0.03% per year) and upward trends in CA-CDI (+0.04% per year). Over time, antibiotics were administered to more patients (+3% per year); the use of high-risk antibiotics declined (–1.2% per year); and antibiotic duration increased in patients with HA-CDI (+4.4% per year). Fewer proton-pump inhibitors and more histamine-2 blockers were used (−3.8% and +7.3% per year, respectively; all Ptrend <.05).

Conclusions:

Although the incidence of HA-CDI decreased over time, CA-CDI simultaneously increased. Continued efforts to assure judicious use of antibiotics in inpatient and community settings is clearly vital. Measuring the actual the level of exposure of an antibiotic (incidence density) should be used for ongoing surveillance and assessment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1048 - 1057
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Burke, KE, Lamont, JT. (2014). Clostridium difficile infection: a worldwide disease. Gut Liver 2014;8:1–6.CrossRefGoogle ScholarPubMed
Riddle, DJD, Dubberke, ERD. Trends in Clostridium difficile disease: epidemiology and intervention. Infect Med 2009;26:211–220.Google Scholar
Acute-care hospital surveillance for C. difficile, MRSA, and other drug-resistant infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/acute-care-hospital/cdiff-mrsa/index.html. Published 2016. Accessed April 11, 2019.Google Scholar
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.CrossRefGoogle ScholarPubMed
van Kleef, E, Green, N, Goldenberg, SD, et al.Excess length of stay and mortality due to Clostridium difficile infection: a multi-state modelling approach. J Hosp Infect 2014;88:213–217.CrossRefGoogle ScholarPubMed
Desai, K, Gupta, SB, Dubberke, ER, Prabhu, VS, Browne, C, Mast, TC. Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach. BMC Infect Dis 2016;16:303.10.1186/s12879-016-1610-3CrossRefGoogle ScholarPubMed
Depestel, DD, Aronoff, DM. Epidemiology of Clostridium difficile infection. J Pharm Pract 2013;26:464–475.CrossRefGoogle ScholarPubMed
Kelly, CP, LaMont JT. Clostridium difficile—more difficult than ever. N Engl J Med 2008;359:1932–1940.CrossRefGoogle Scholar
Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.CrossRefGoogle ScholarPubMed
Kuijper, EJ, Coignard, B, Brazier, JS, et al.Update of Clostridium difficile–associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007;12(6):E1–E2.CrossRefGoogle ScholarPubMed
Patton, A, Davey, P, Harbarth, S, Nathwani, D, Sneddon, J, Marwick, CA. Impact of antimicrobial stewardship interventions on Clostridium difficile infection and clinical outcomes: segmented regression analyses. J Antimicrob Chemother 2017;73:517–526.CrossRefGoogle Scholar
Balsells, E, Filipescu, T, Kyaw, MH, Wiuff, C, Campbell, H, Nair, H. Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations. J Glob Health 2016;6(2):020410.CrossRefGoogle Scholar
Bartlett, JG, Gerding, DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008;46 suppl 1:S12–S18.CrossRefGoogle Scholar
Eze, P, Balsells, E, Kyaw, MH, Nair, H. Risk factors for Clostridium difficile infections—an overview of the evidence base and challenges in data synthesis. J Glob Health 2017;7(1):010417.CrossRefGoogle ScholarPubMed
Trifan, A, Stanciu, C, Girleanu, I, et al.Proton pump inhibitors therapy and risk of Clostridium difficile infection: systematic review and meta-analysis. World J Gastroenterol 2017;23:6500–6515.CrossRefGoogle ScholarPubMed
Weber, DJ, Anderson, D, Rutala, WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338–344.Google ScholarPubMed
Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, Donskey, CJ. Clostridium difficile skin contamination in patients with C. difficile-associated disease. Clin Infect Dis 2008;46:447–450.10.1086/525267CrossRefGoogle ScholarPubMed
Identifying healthcare-associated infections (HAI) for NHSN surveillance. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/2psc_identifyinghais_nhsncurrent.pdf. Published 2017. Accessed January 20, 2020.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
Slimings, C, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother 2013;69:881–891.CrossRefGoogle ScholarPubMed
Thomas, C, Stevenson, M, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review. J Antimicrob Chemother 2003;51:1339–1350.CrossRefGoogle ScholarPubMed
Song, PH, Min, JH, Kim, YS, et al.Rapid and accurate diagnosis of Clostridium difficile infection by real-time polymerase chain reaction. Intest Res 2018;16:109–115.CrossRefGoogle ScholarPubMed
Murad, YM, Perez, J, Nokhbeh, R, et al.Impact of polymerase chain reaction testing on Clostridium difficile infection rates in an acute health care facility. Am J Infect Control 2015;43:383–386.CrossRefGoogle Scholar
Berry, N, Sewell, B, Jafri, S, et al.Real-time polymerase chain reaction correlates well with clinical diagnosis of Clostridium difficile infection. J Hosp Infect 2014;87:109–114.CrossRefGoogle ScholarPubMed
Burns, L, Berger, J, Pozzuoli, L, Woods, B. Decreasing hospital-onset Clostridium difficile using conventional quality improvement methods. Am J Infect Control 2017; 45(6):S99.CrossRefGoogle Scholar
Zacharioudakis, IM, Zervou, FN, Shehadeh, F, Mylona, EK, Mylonakis, E. Association of community factors with hospital-onset Clostridioides (Clostridium) difficile infection: a population based US-wide study. EClin Med 2019;8:12–19.Google Scholar
Current HAI progress report: 2018 national and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html?deliveryName=USCDC_425-DHQP-DM12147. Published 2018. Accessed November 1, 2019.Google Scholar
Reveles, KR, Pugh, MJV, Lawson, KA, et al.Shift to community-onset Clostridium difficile infection in the national Veterans’ Health Administration, 2003–2014. Am J Infect Control 2018;46:431–435.CrossRefGoogle Scholar
Gupta, A, Khanna, S. Community-acquired Clostridium difficile infection: an increasing public health threat. Infect Drug Resist 2014;7:63–72.Google Scholar
Barker, AK, Alagoz, O, Safdar, N. Interventions to reduce the incidence of hospital-onset Clostridium difficile infection: an agent-based modeling approach to evaluate clinical effectiveness in adult acute-care hospitals. Clin Infect Dis 2017;66:1192–1203.CrossRefGoogle Scholar
Hawker, JI, Smith, S, Smith, GE, et al.Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995–2011: analysis of a large database of primary care consultations. J Antimicrob Chemother 2014;69:3423–3430.CrossRefGoogle ScholarPubMed
Luo, H, Fan, Q, Xiao, S, Chen, K. Changes in proton pump inhibitor prescribing trend over the past decade and pharmacists’ effect on prescribing practice at a tertiary hospital. BMC Health Serv Res 2018;18:537.CrossRefGoogle ScholarPubMed
Khanna, S, Aronson, SL, Kammer, PP, Baddour, LM, Pardi, DS. Gastric acid suppression and outcomes in Clostridium difficile infection: a population-based study. Mayo Clin Proc 2012;87:636–642.CrossRefGoogle ScholarPubMed
McDonald, EG, Milligan, J, Frenette, C, Lee, TC. Continuous proton pump inhibitor therapy and the associated risk of recurrent Clostridium difficile infection. JAMA Intern Med 2015;175:784–791.CrossRefGoogle ScholarPubMed
Abdelfatah, M, Nayfe, R, Nijim, A, et al.Factors predicting recurrence of Clostridium difficile infection (CDI) in hospitalized patients: retrospective study of more than 2000 patients. J Investig Med 2015;63:747–751.CrossRefGoogle ScholarPubMed
Minson, Q, Mok, S. Relationship between antibiotic exposure and subsequent Clostridium difficile–associated diarrhea. Hosp Pharm 2007;42:430–434.CrossRefGoogle Scholar
Baxter, R, Ray, GT, Fireman, BH. Case-control study of antibiotic use and subsequent Clostridium difficile–associated diarrhea in hospitalized patients. Infect Control Hosp Epidemiol 2008;29:44–50.CrossRefGoogle ScholarPubMed
Brown, KA, Fisman, DN, Moineddin, R, Daneman, N. The magnitude and duration of Clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study. PLoS One 2014;9(8):e105454.CrossRefGoogle ScholarPubMed
Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:42–48.CrossRefGoogle ScholarPubMed
Guidelines for ATC classification and DDD assignment 2018. World Health Organization Collaborating Centre for Drug Statistics Methodology website. https://www.whocc.no/filearchive/publications/2019_guidelines_web.pdf. Published 2017. Accessed December 1, 2019.Google Scholar
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