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A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

Published online by Cambridge University Press:  21 September 2015

Sara Y. Tartof ,
Gunter K. Rieg ,
Rong Wei ,
Hung Fu Tseng ,
Steven J. Jacobsen  and
Kalvin C. Yu
Sara Y. Tartof*
Affiliation:
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Gunter K. Rieg
Affiliation:
Department of Infectious Diseases, Southern California Permanente Medical Group, Harbor City, California
Rong Wei
Affiliation:
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Hung Fu Tseng
Affiliation:
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Steven J. Jacobsen
Affiliation:
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
Kalvin C. Yu
Affiliation:
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California Department of Medicine, Infectious Disease/Infection Control, New York University School of Medicine, New York, New York
*
Address correspondence to Sara Y. Tartof, PhD, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 2nd Fl, Pasadena, CA 91101 ([email protected]).
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Abstract

BACKGROUND

Limitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).

OBJECTIVE

To incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.

DESIGN

Retrospective cohort study.

SETTING

Kaiser Permanente Southern California.

PATIENTS

Members of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.

METHODS

Hospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.

RESULTS

A total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.

CONCLUSIONS

Although type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.

Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 12 , December 2015 , pp. 1409 - 1416
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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