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Predicting the Risk for Hospital-Onset Clostridium difficile Infection (HO-CDI) at the Time of Inpatient Admission: HO-CDI Risk Score

  • Ying P. Tabak (a1), Richard S. Johannes (a1) (a2), Xiaowu Sun (a1), Carlos M. Nunez (a1) (a3) and L. Clifford McDonald (a4)...



To predict the likelihood of hospital-onset Clostridium difficile infection (HO-CDI) based on patient clinical presentations at admission


Retrospective data analysis


Six US acute care hospitals


Adult inpatients


We used clinical data collected at the time of admission in electronic health record (EHR) systems to develop and validate a HO-CDI predictive model. The outcome measure was HO-CDI cases identified by a nonduplicate positive C. difficile toxin assay result with stool specimens collected >48 hours after inpatient admission. We fit a logistic regression model to predict the risk of HO-CDI. We validated the model using 1,000 bootstrap simulations.


Among 78,080 adult admissions, 323 HO-CDI cases were identified (ie, a rate of 4.1 per 1,000 admissions). The logistic regression model yielded 14 independent predictors, including hospital community onset CDI pressure, patient age ≥65, previous healthcare exposures, CDI in previous admission, admission to the intensive care unit, albumin ≤3 g/dL, creatinine >2.0 mg/dL, bands >32%, platelets ≤150 or >420 109/L, and white blood cell count >11,000 mm3. The model had a c-statistic of 0.78 (95% confidence interval [CI], 0.76–0.81) with good calibration. Among 79% of patients with risk scores of 0–7, 19 HO-CDIs occurred per 10,000 admissions; for patients with risk scores >20, 623 HO-CDIs occurred per 10,000 admissions (P<.0001).


Using clinical parameters available at the time of admission, this HO-CDI model demonstrated good predictive ability, and it may have utility as an early risk identification tool for HO-CDI preventive interventions and outcome comparisons.

Infect Control Hosp Epidemiol 2015;00(0):1–7


Corresponding author

Address all correspondence to L. Clifford McDonald, MD, FACP, Senior Advisor for Science and Integrity, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724 (


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PREVIOUS PRESENTATION. The preliminary data were presented in part as a poster at the IDWEEK, October, 2012, San Diego, California.



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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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