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Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

Published online by Cambridge University Press:  02 January 2015

Aurora Pop-Vicas ,
Eman Shaban ,
Cecile Letourneau  and
Angel Pechie
Aurora Pop-Vicas*
Affiliation:
Memorial Hospital of Rhode Island, Pawtucket, Rhode Island Warren Alpert Medical School of Brown University, Providence, Rhode Island
Eman Shaban
Affiliation:
Memorial Hospital of Rhode Island, Pawtucket, Rhode Island Warren Alpert Medical School of Brown University, Providence, Rhode Island
Cecile Letourneau
Affiliation:
Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
Angel Pechie
Affiliation:
Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
*
Division of Infectious Diseases, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860 (aurora_pop-vicas@brown.edu)
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Abstract

Objective.

To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.

Design.

Retrospective cohort study.

Setting.

University-affiliated community hospital.

Methods.

We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.

Results.

Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.

Conclusions.

Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1101 - 1106
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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