Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-31T21:34:40.845Z Has data issue: false hasContentIssue false
  • English
  • Français

Association between prevalence of laboratory-identified Clostridioides difficile infection (CDI) and antibiotic treatment for CDI in US acute-care hospitals, 2019

Published online by Cambridge University Press:  24 January 2022

Kerui Xu Open the ORCID record for Kerui Xu [Opens in a new window] ,
Hsiu Wu Open the ORCID record for Hsiu Wu [Opens in a new window] ,
Qunna Li ,
Jonathan R. Edwards ,
Erin N. O’Leary ,
Denise Leaptrot Open the ORCID record for Denise Leaptrot [Opens in a new window]  and
Andrea L. Benin
Kerui Xu*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Hsiu Wu*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Qunna Li
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Erin N. O’Leary
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Denise Leaptrot
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Andrea L. Benin
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Kerui Xu, E-mail: kerui.xu@fda.hhs.gov. Or Hsiu Wu, E-mail: xdh6@cdc.gov.
Author for correspondence: Kerui Xu, E-mail: kerui.xu@fda.hhs.gov. Or Hsiu Wu, E-mail: xdh6@cdc.gov.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate hospital-level variation in using first-line antibiotics for Clostridioides difficile infection (CDI) based on the burden of laboratory-identified (LabID) CDI.

Methods:

Using data on hospital-level LabID CDI events and antimicrobial use (AU) for CDI (oral/rectal vancomycin or fidaxomicin) submitted to the National Healthcare Safety Network in 2019, we assessed the association between hospital-level CDI prevalence (per 100 patient admissions) and rate of CDI AU (days of therapy per 1,000 days present) to generate a predicted value of AU based on CDI prevalence and CDI test type using negative binomial regression. The ratio of the observed to predicted AU was then used to identify hospitals with extreme discordance between CDI prevalence and CDI AU, defined as hospitals with a ratio outside of the intervigintile range.

Results:

Among 963 acute-care hospitals, rate of CDI prevalence demonstrated a positive dose–response relationship with rate of CDI AU. Compared with hospitals without extreme discordance (n = 902), hospitals with lower-than-expected CDI AU (n = 31) had, on average, fewer beds (median, 106 vs 208), shorter length of stay (median, 3.8 vs 4.2 days), and higher proportion of undergraduate or nonteaching medical school affiliation (48% vs 39%). Hospitals with higher-than-expected CDI AU (n = 30) were similar overall to hospitals without extreme discordance.

Conclusions:

The prevalence rate of LabID CDI had a significant dose–response association with first-line antibiotics for treating CDI. We identified hospitals with extreme discordance between CDI prevalence and CDI AU, highlighting potential opportunities for data validation and improvements in diagnostic and treatment practices for CDI.

Keywords

Clostridioidesdifficileantimicrobial useantibioticsNational Healthcare Safety Network
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 12 , December 2022 , pp. 1847 - 1852
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. A preliminary report of this research was presented at IDWeek, October 21–25, 2020. Philadelphia, Pennsylvania.

References

Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Published 2019. Accessed December 30, 2020.Google Scholar
Clostridioides difficile (C. diff), FAQs for Clinicians about C. diff. Centers for Disease Control and Prevention website. https://www.cdc.gov/cdiff/clinicians/faq.html. Published 2020. Accessed Febuarary 29, 2021.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: e1–e48.CrossRefGoogle Scholar
NHSN multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf. Published 2021. Accessed March 30, 2021.Google Scholar
Patel, S, Preuss, CV, Vancomycin, Bernice F.. Treasure Island, FL: StatPearls Publishing; 2021.Google Scholar
Fang, FC, Polage, CR, Wilcox, H. Point-counterpoint: what is the optimal approach for detection of Clostridium difficile infection? J Clin Microbiol 2017; 55: 670–680.Google ScholarPubMed
Hilbe, JM. Negative Binomial Regression, 2nd ed. London: Cambridge University Press; 2011.CrossRefGoogle Scholar
Stenehjem, E, Hyun, DY, Septimus, E, et al. Antibiotic stewardship in small hospitals: barriers and potential solutions. Clin Infect Dis 2017; 65: 691–696.CrossRefGoogle ScholarPubMed
Johannsson, B, Beekmann, SE, Srinivasan, A, Hersh, AL, Laxminarayan, R, Polgreen, PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011; 32: 367–374.CrossRefGoogle ScholarPubMed
Stevenson, KB, Samore, M, Barbera, J, et al. Pharmacist involvement in antimicrobial use at rural community hospitals in four western states. Am J Heal Pharm 2004; 61: 787–792.CrossRefGoogle ScholarPubMed
Doron, S, Nadkarni, L, Lyn Price, L, et al. A nationwide survey of antimicrobial stewardship practices. Clin Ther 2013; 35: 758–765.CrossRefGoogle ScholarPubMed
Pollack, LA, Van Santen, KL, Weiner, LM, Dudeck, MA, Edwards, JR, Srinivasan, A. Antibiotic stewardship programs in US acute-care hospitals: findings from the 2014 national healthcare safety network annual hospital survey. Clin Infect Dis 2016; 63: 443–449.CrossRefGoogle ScholarPubMed
Vaughan, L, Edwards, N. The problems of smaller, rural and remote hospitals: separating facts from fiction. Futur Healthc J 2020; 7: 38–45.CrossRefGoogle ScholarPubMed
Peng, Z, Ling, L, Stratton, CW, et al. Advances in the diagnosis and treatment of Clostridium difficile infections review article. Emerg Microbes Infect 2018;7:15.CrossRefGoogle Scholar
Gallagher, JC, Reilly, JP, Navalkele, B, Downham, G, Haynes, K, Trivedi, M. Clinical and economic benefits of fidaxomicin compared to vancomycin for Clostridium difficile infection. Antimicrob Agents Chemother 2015; 59: 7007–7010.CrossRefGoogle ScholarPubMed
Novosad, SA, Mu, Y, Winston, LG, et al. Treatment of Clostridioides difficile infection and non-compliance with treatment guidelines in adults in 10 US geographical locations, 2013–2015. J Gen Intern Med 2020; 35: 412–419.Google Scholar
Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines 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: 431-55.Google Scholar
Fabre, V, Dzintars, K, Avdic, E, Cosgrove, SE. Role of metronidazole in mild Clostridium difficile infections. Clin Infect Dis 2018; 67: 1956–1958.Google ScholarPubMed
Compilation of Patient Protection and Affordable Care Act. Patient Protection and Affordable Care Act health-related portions of the Health Care and Education Reconciliation Act of 2010. US Health and Human Services website. https://www.hhs.gov/sites/default/files/ppacacon.pdf. Published 2010. Accessed February 29, 2021.Google Scholar
Department of Health and Human Services; Centers for Medicare & Medicaid. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care; hospital prospective payment system and fiscal year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status; final rule. Fed Regist 2013; 78: 496–451.Google Scholar
Madden, GR, German Mesner, I, Cox, HL, et al. Reduced Clostridium difficile tests and laboratory-identified events with a computerized clinical decision support tool and financial incentive. Infect Control Hosp Epidemiol 2018; 39: 737–740.Google ScholarPubMed
Rock, C, Pana, Z, Leekha, S, et al. National Healthcare Safety Network laboratory-identified difficile event reporting: a need for diagnostic stewardship. Am J Infect Control 2018; 46: 456–458.Google ScholarPubMed
Johnson, S, Lavergne, V, Skinner, AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 2021;ciab549.Google Scholar