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Characterizing Clostridioides difficile infections and hospital exposures in California using surveillance and administrative data, 2014–2015
Published online by Cambridge University Press: 30 September 2020
Abstract
Objective:
To evaluate a method to identify hospitals contributing to Clostridioides difficile infections (CDI) at subsequent hospitalizations.
Design:
Retrospective cohort study.
Methods:
We merged 2014–2015 National Healthcare Safety Network (NHSN) inpatient CDI laboratory-identified events with hospital patient discharge data. For patients with incident community-onset CDI (CO CDI), we identified immediately preceding admissions (within 12 weeks) unrelated to CDI at different (exposure) hospitals. We calculated an exposure rate, and we selected hospitals with the highest (90th–100th percentile) rates by hospital type and compared these rates with reported standardized infection ratios (SIR) for CDI.
Results:
We successfully matched 44,691 of 58,842 NHSN CDI records (76.0%) with a hospital discharge record. Among 36,215 unique matched records, 5,234 (14.5%) had an admission not related to CDI within 12 weeks prior to an incident CO CDI event, and 1,574 of these admissions (30.1%) occurred in a different hospital. For 33 hospitals with an exposure ranking within the 90th–100th percentile, CDI SIRs for 22 (66.7%) were not significantly different; 3 (9.1%) were lower; and 8 (24.2%) were higher than the national baseline. Also, 12 (36.4%) had an SIR ≤1.0.
Conclusions:
The identification of high-ranked exposure hospitals presents an alternative to SIR for measuring the contribution of hospitals to the CDI burden across the continuum of care. Further exploration of the potential factors leading to high exposure rank, such as antibiotic use and infection control practices, is indicated and may inform CDI prevention outreach to healthcare facilities and provider networks in California and elsewhere.
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- Original Article
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- © 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
Footnotes
PREVIOUS PRESENTATION. Preliminary results of this manuscript were presented during a poster abstract session on October 4, 2018 at IDWeek, in San Francisco.
References
Making healthcare safer for all californians, healthcare-associated infections in california hospitals annual report, 2018. California Department of Public Health, Center for Health Care Quality, Healthcare-Associated Infections Program website. https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/AnnualHAIReports.aspx. Updated February 14, 2020. Accessed December 6, 2019. Reported HAIs include central-line–associated bloodstream infections (CLABSI), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, vancomycin-resistant Enterococci (VRE) bloodstream infections, Clostridioides difficile infections (CDI), and surgical site infections (SSIs) for 28 surgical procedures.Google Scholar
Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
Hall, AJ, Curns, AT, McDonald, LC, Parashar, UD, Lopman, BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999–2007. Clin Infect Dis 2012;55:216–223.CrossRefGoogle ScholarPubMed
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
Bignardi, GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1–15.CrossRefGoogle ScholarPubMed
Hensgens, MP, Goorhuis, A, Dekkers, OM, Kuijper, EJ. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 2012;67:742–748.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Regional Prevention Collaboratives. California Department of Public Health, Center for Health Care Quality, Healthcare-Associated Infections Program website. https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/Regional_AR_Collaboratives.aspx. Updated October 18, 2019. Accessed August 2, 2020.Google Scholar
California’s Office of Statewide Health Planning and Development. California’s Office of Statewide Health Planning and Development website. https://oshpd.ca.gov/. Accessed August 2, 2020.Google Scholar
The NHSN standardized infection ratio (SIR), a guide to the SIR. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf. Updated March 2019. Accessed August 2, 2020.Google Scholar
National Health Safety Network multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Updated January 2020. Accessed August 2, 2020.Google Scholar
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.CrossRefGoogle Scholar
Lee, S, Ronksley, P, Conly, J, et al. Using data linkage methodologies to augment healthcare-associated infection surveillance data. Infect Control Hosp Epidemiol 2019;40:1144–1150.CrossRefGoogle ScholarPubMed
Yi, SH, Perkins, KM, Kazakova, SV, et al. Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance. Infect Control Hosp Epidemiol 2019;40:639–648.CrossRefGoogle ScholarPubMed
Redondo-González, O, Tenías, JM, Arias, Á, Lucendo, AJ. Validity and reliability of administrative coded data for the identification of hospital-acquired infections: an updated systematic review with meta-analysis and meta-regression analysis. Health Serv Res 2018;53:1919–1956.CrossRefGoogle ScholarPubMed
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;58:688–696.CrossRefGoogle ScholarPubMed
Hatfield, KM, Baggs, J, Winston, LG, et al. Prior hospitalizations among cases of community-associated Clostridioides difficile infection—10 US states, 2014–2015. Paper 837, presented at the Open Forum for Infectious Diseases, 2019.CrossRefGoogle Scholar
Mitchell, BG, Gardner, A. Mortality and Clostridium difficile infection: a review. Antimicrob Resist Infect Control 2012;1:20.CrossRefGoogle ScholarPubMed
What is C. diff? Centers for Disease Control and Prevention website. https://www.cdc.gov/cdiff/what-is.html. Updated March 27, 2020. Accessed December 31, 2019.Google Scholar
Garg, S, Mirza, YR, Girotra, M, et al. Epidemiology of Clostridium difficile–associated disease (CDAD): a shift from hospital-acquired infection to long-term care facility-based infection. Digest Dis Sci 2013;58:3407–3412.CrossRefGoogle ScholarPubMed
Campbell, RJ, Giljahn, L, Machesky, K, et al.
Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30:526–533.CrossRefGoogle ScholarPubMed
Chopra, T, Goldstein, EJ.
Clostridium difficile infection in long-term care facilities: a call to action for antimicrobial stewardship. Clin Infect Dis 2015;60:S72–S76.CrossRefGoogle Scholar