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Trends in facility-level rates of Clostridioides difficile infections in US hospitals, 2019–2020

Published online by Cambridge University Press:  19 May 2022

Ashley N. Rose Open the ORCID record for Ashley N. Rose [Opens in a new window] ,
James Baggs Open the ORCID record for James Baggs [Opens in a new window] ,
Sophia V. Kazakova Open the ORCID record for Sophia V. Kazakova [Opens in a new window] ,
Alice Y. Guh ,
Sarah H. Yi Open the ORCID record for Sarah H. Yi [Opens in a new window] ,
Natalie L. McCarthy ,
John A. Jernigan  and
Sujan C. Reddy Open the ORCID record for Sujan C. Reddy [Opens in a new window]
Ashley N. Rose*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
James Baggs
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sophia V. Kazakova
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alice Y. Guh
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah H. Yi
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Natalie L. McCarthy
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sujan C. Reddy
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Ashley N. Rose, E-mail: OUM0@cdc.gov
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Abstract

Objectives:

The coronavirus disease 2019 pandemic caused substantial changes to healthcare delivery and antibiotic prescribing beginning in March 2020. To assess pandemic impact on Clostridioides difficile infection (CDI) rates, we described patients and trends in facility-level incidence, testing rates, and percent positivity during 2019–2020 in a large cohort of US hospitals.

Methods:

We estimated and compared rates of community-onset CDI (CO-CDI) per 10,000 discharges, hospital-onset CDI (HO-CDI) per 10,000 patient days, and C. difficile testing rates per 10,000 discharges in 2019 and 2020. We calculated percent positivity as the number of inpatients diagnosed with CDI over the total number of discharges with a test for C. difficile. We used an interrupted time series (ITS) design with negative binomial and logistic regression models to describe level and trend changes in rates and percent positivity before and after March 2020.

Results:

In pairwise comparisons, overall CO-CDI rates decreased from 20.0 to 15.8 between 2019 and 2020 (P < .0001). HO-CDI rates did not change. Using ITS, we detected decreasing monthly trends in CO-CDI (−1% per month, P = .0036) and HO-CDI incidence (−1% per month, P < .0001) during the baseline period, prior to the COVID-19 pandemic declaration. We detected no change in monthly trends for CO-CDI or HO-CDI incidence or percent positivity after March 2020 compared with the baseline period.

Conclusions:

While there was a slight downward trajectory in CDI trends prior to March 2020, no significant change in CDI trends occurred during the COVID-19 pandemic despite changes in infection control practices, antibiotic use, and healthcare delivery.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 2 , February 2023 , pp. 238 - 245
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Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Centers for Disease Control and Prevention, 2022

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References

Magill, SS, O’Leary, E, Janelle, SJ, et al. Changes in prevalence of healthcare-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Kazakova, SV, Baggs, J, McDonald, LC, et al. Association between antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2006–2012: an ecologic analysis. Clin Infect Dis 2020;70:11–18.CrossRefGoogle ScholarPubMed
Kazakova, SV, Baggs, J, Yi, SH, et al. Associations of facility-level antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2012–2018. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.151.Google ScholarPubMed
Rose, AN, Baggs, J, Wolford, H, et al. Trends in antibiotic use in US hospitals during the coronavirus disease 2019 pandemic. Open Forum Infect Dis 2021;8 :ofab236.CrossRefGoogle Scholar
King, LM, Lovegrove, MC, Shehab, N, et al. Trends in US outpatient antibiotic prescriptions during the coronavirus disease 2019 pandemic. Clin Infect Dis 2020:e652–e660.Google Scholar
Hartnett, KP, Kite-Powell, A, DeVies, J, et al. Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019-May 30, 2020. Morb Mortal Wkly Rep 2020;69:699–704.CrossRefGoogle Scholar
Patel, SY, Mehrotra, A, Huskamp, HA, Uscher-Pines, L, Ganguli, I, Barnett, ML. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med 2021;181:388–391.CrossRefGoogle ScholarPubMed
Mehrotra Ateev, CM, Linetsky David, Hatch Hilary, David, Cutler, Schneider Eric, C. The impact of the COVID-19 pandemic on outpatient care: visits return to prepandemic levels, but not for all providers and patients. Commonwealth Fund website. https://www.commonwealthfund.org/publications/2020/oct/impact-covid-19-pandemic-outpatient-care-visits-return-prepandemic-levels. Published 2020. Accessed June 25, 2021.Google Scholar
Heist, T SK, Butler, S. Trends in overall and non–COVID-19 hospital admissions. Kaiser Family Foundation website. https://www.kff.org/health-costs/issue-brief/trends-in-overall-and-non-covid-19-hospital-admissions/. Published 2021. Accessed July 28, 2021.Google Scholar
The Premier healthcare database (COVID-19): data that informs and performs. Premier website. http://offers.premierinc.com/rs/381-NBB-525/images/PHD_COVID-19_White_Paper.pdf. Published April 10, 2020. Accessed May 31, 2021.Google Scholar
Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
Penfold, RB, Zhang, F. Use of interrupted time series analysis in evaluating healthcare quality improvements. Acad Pediatr 2013;13 supple 6:S38–S44.CrossRefGoogle Scholar
Allegretti, JR, Nije, C, McClure, E, et al. Prevalence and impact of Clostridioides difficile infection among hospitalized patients with coranavirus disease 2019. JGH Open 2021;5:622–625.CrossRefGoogle ScholarPubMed
Gondi, S, Beckman, AL, Deveau, N, et al. Personal protective equipment needs in the USA during the COVID-19 pandemic. Lancet 2020;395:e90–e91.CrossRefGoogle ScholarPubMed
Hawes, AM, Desai, A, Patel, PK. Did Clostridioides difficile testing and infection rates change during the COVID-19 pandemic? Anaerobe 2021;70:102384.CrossRefGoogle ScholarPubMed
Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Published 2021. Accessed November 10, 2021.Google Scholar
Baker, MA, Sands, KE, Huang, SS, et al. The impact of COVID-19 on healthcare-associated infections. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2021:ciab688.Google Scholar
Weiner-Lastinger, LM, Pattabiraman, V, Konnor, RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2022;43:12–25.CrossRefGoogle Scholar
Solanky, D, Juang, DK, Johns, ST, Drobish, IC, Mehta, SR, Kumaraswamy, M. Using diagnostic stewardship to reduce rates, healthcare expenditures and accurately identify cases of hospital-onset Clostridioides difficile infection. Infect Control Hosp Epidemiol 2021;42:51–56.CrossRefGoogle ScholarPubMed
Kang, M, Abeles, SR, El-Kareh, R, et al. The effect of Clostridioides difficile diagnostic stewardship interventions on the diagnosis of hospital-onset C. difficile infections. Jt Comm J Qual Patient Saf 2020;46:457–463.Google Scholar
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(7):e1–e48.CrossRefGoogle Scholar
Bunnell, KL, Danziger, LH, Johnson, S. Economic barriers in the treatment of Clostridium difficile infection with oral vancomycin. Open Forum Infect Dis 2017;4:ofx078.CrossRefGoogle ScholarPubMed
2019 National and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Published 2019. Accessed July 22, 2021.Google Scholar
Lewandowski, K, Rosołowski, M, Kaniewska, M, et al. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med 2021;131:121–127.Google ScholarPubMed
Premier healthcare database white paper: data that informs and performs. Premier Applied Sciences website. https://learn.premierinc.com/white-papers/premier-healthcaredatabase-whitepaper. Published 2020. Accessed April 21, 2022.Google Scholar
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