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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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