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Impact of Change to Molecular Testing for Clostridium difficile Infection on Healthcare Facility–Associated Incidence Rates

Published online by Cambridge University Press:  28 May 2015

Rebekah W. Moehring*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Department of Medicine, Division of Infectious Diseases, Durham Veterans Administration Medical Center, Durham, North Carolina
Eric T. Lofgren
Affiliation:
Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Deverick J. Anderson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
*
P.O. Box 102359, Duke University Medical Center, Durham, NC 27710 ([email protected])

Abstract

Background.

Change from nonmolecular to molecular testing techniques is thought to contribute to the increasing trend in incidence of Clostridium difficile infection (CDI); however the degree of effect attributed to this versus other time-related epidemiologic factors is unclear.

Methods.

We compared the relative change in incidence rate (IRR) of healthcare facility–associated (HCFA) CDI among hospitals in the Duke Infection Control Outreach Network before and after the date of switch from nonmolecular tests to polymerase chain reaction (PCR) using prospectively collected surveillance data from July 2009 to December 2011. Data from 10 hospitals that switched and 22 control hospitals were included. Individual hospital estimates were determined using Poisson regression. We used an interrupted time series approach to develop a Poisson mixed-effects model. Additional regression adjustments were made for clustering and proportion of intensive care unit patient-days. The variable for PCR was treated as a fixed effect; other modeled variables were random effects.

Results.

For those hospitals that switched to PCR, mean incidence rate of HCFA CDI before the switch was 6.0 CDIs per 10,000 patient-days compared with 9.6 CDIs per 10,000 patient-days after the switch. Estimates of hospital-specific IRR that compared after the switch with before the switch ranged from 0.89 (95% confidence interval [CI], 0.32–2.44) to 6.91 (95% CI, 1.12–42.54). After adjustment in the mixed-effects model, the overall IRR comparing CDI incidence after the switch to before the switch was 1.56 (95% CI, 1.28–1.90). Time-trend variables did not reach statistical significance.

Conclusion.

Hospitals that switched from nonmolecular to molecular tests experienced an approximate 56% increase in the rate of HCFA CDI after testing change.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guide-lines 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;31:431455.Google Scholar
2.Scott, RD. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. 2009. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed December 10, 2012.Google Scholar
3.Dubberke, ER, Reske, KA, Olsen, MA, McDonald, LC, Fraser, VJ. Short- and long-term attributable costs of Clostridium difficile–associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497504.Google Scholar
4.Freeman, J, Bauer, MP, Baines, SD, et al.The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 2010;23:529549.Google Scholar
5.Dubberke, ER, Butler, AM, Yokoe, DS, et al.Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262268.CrossRefGoogle ScholarPubMed
6.Dubberke, ER, Butler, AM, Hota, B, et al.Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. difficile infection. Infect Control Hosp Epidemiol 2009;30:518525.Google Scholar
7.Ricciardi, R, Rothenberger, DA, Madoff, RD, Baxter, NN. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 2007;142:624631; discussion, 631.Google Scholar
8.McDonald, LC, Jernigan, DB. Increasing incidence of Clostridium difficile–associated disease in U.S. acute care hospitals, 1993–2001. Paper presented at: 14th Annual Meeting of the Society for Healthcare Epidemiology of America; April 18, 2004; Alexandria, VA.Google Scholar
9.Miller, BA, Chen, LF, Sexton, DJ, Anderson, DJ. Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 2011;32:387390.Google Scholar
10.Bartlett, IG. Clostridium difficile: progress and challenges. Ann N Y Acad Sci 2010;1213:6269.Google Scholar
11.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.CrossRefGoogle ScholarPubMed
12.Warny, M, Pepin, I, 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;366:10791084.Google Scholar
13.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:24422449.CrossRefGoogle ScholarPubMed
14.Pepin, J, Saheb, N, Coulombe, MA, et al.Emergence of fluoro-quinolones as the predominant risk factor for Clostridium difficile–associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:12541260.Google Scholar
15.Birgand, G, Miliani, K, Carbonne, A, Astagneau, P. Is high consumption of antibiotics associated with Clostridium difficile polymerase chain reaction-ribotype 027 infections in France? Infect Control Hosp Epidemiol 2010;31:302305.Google Scholar
16.Loo, VG, Bourgault, AM, Poirier, L, et al.Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011;365:16931703.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 2007;28:140145.CrossRefGoogle ScholarPubMed
18.Carroll, KC. Tests for the diagnosis of Clostridium difficile infection: the next generation. Anaerobe 2011;17:170174.Google Scholar
19.Chapin, KC, Dickenson, RA, Wu, F, Andrea, SB. Comparison of five assays for detection of Clostridium difficile toxin. J Mol Diagn 2011;13:395400.CrossRefGoogle ScholarPubMed
20.Selvaraju, SB, Gripka, M, Estes, K, Nguyen, A, Jackson, MA, Selvarangan, R. Detection of toxigenic Clostridium difficile in pediatric stool samples: an evaluation of Quik Check Complete Antigen assay, BD GeneOhm Cdiff PCR, and ProGastro Cd PCR assays. Diagn Microbiol Infect Dis 2011;71:224229.Google Scholar
21.Longtin, Y, Trottier, S, Brochu, G, et al.Impact of the type of diagnostic assay on Clostridium difficile infection and complication rates in a mandatory reporting program. Clin Infect Dis 2013;56:6773.Google Scholar
22.Fong, KS, Fatica, C, Hall, G, et al.Impact of PCR testing for Clostridium difficile on incident rates and potential on public reporting: is the playing field level? Infect Control Hosp Epidemiol 2011;32:932933.CrossRefGoogle ScholarPubMed
23.Gould, G, Edwards, J, Cohen, J, et al.Effect of nucleic acid amplification testing on population-based incidence rates of Clostridium difficile infection. Paper presented at: ID Week; October 17–22, 2012; San Diego, CA.Google Scholar
24.Goldenberg, SD, Price, NM, Tucker, D, Wade, P, French, GL. Mandatory reporting and improvements in diagnosing Clostridium difficile infection: an incompatible dichotomy? J Infect 2011;62:363370.Google Scholar
25.Anderson, DJ, Miller, BA, Chen, LF, et al.The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315322.Google Scholar
26.Benneyan, JC. Statistical quality control methods in infection control and hospital epidemiology, part II: chart use, statistical properties, and research issues. Infect Control Hosp Epidemiol 1998;19:265283.CrossRefGoogle ScholarPubMed
27.Naumova, EN, Must, A, Laird, NM. Tutorial in biostatistics: evaluating the impact of “critical periods” in longitudinal studies of growth using piecewise mixed effects models. Int J Epidemiol 2001;30:13321341.Google Scholar
28.Eastwood, K, Else, P, Charlett, A, Wilcox, M. Comparison of nine commercially available Clostridium difficile toxin detection assays, a real-time PCR assay for C. difficile tcdB, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods. J Clin Microbiol 2009;47:32113217.Google Scholar
29.Centers for Disease Control and Prevention. Vital signs: preventing Clostridium difficile infections. MMWR Morb Mortal Wkly Rep 2012;61:157162.Google Scholar
30.Lucado, J, Gould, C, Elixhauser, A. Clostridium difficile infections (CDI) in hospital stays, 2009. HCUP statistical brief. 2011. http://www.hcup-us.ahrq.gov/reports/statbriefs/sbl24.pdf. Accessed December 10, 2012.Google Scholar
31.Dudeck, M, Malpiedi, P, Edwards, J, Fridkin, S, McDonald, LC, Sievert, S. Risk adjustment for healthcare facility-onset C. difficile infection and MRSA bacteremia reporting in NHSN. Presented at: ID Week; October 17–22, 2012; San Diego, CA.Google Scholar
32.Goldenberg, SD, French, GL. Diagnostic testing for Clostridium difficile: a comprehensive survey of laboratories in England. J Hosp Infect 2011;79:47.Google Scholar