Burden and risk factors for inappropriate Clostridioides Difficile infection testing among hospitalized patients

2021 ◽  
Vol 99 (4) ◽  
pp. 115283
Author(s):  
Ellen Axenfeld ◽  
William G. Greendyke ◽  
Jianhua Li ◽  
Daniel A. Green ◽  
Susan Whittier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals 803. Risk factors associated with Clostridioides difficile infection in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S445-S445
Author(s):  
William Justin Moore ◽  
Caroline C Jozefczyk ◽  
Paul R Yarnold ◽  
Karolina Harkabuz ◽  
Valerie Widmaier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decomposition Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Structural Decomposition Analysis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Pre Treatment ◽  
Healthcare Associated

Abstract Background Patients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP. Methods Design: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1). Results A total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s< 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%). Conclusion We identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted. Disclosures All Authors: No reported disclosures

scholarly journals S1238 Risk Factors for Inappropriate Clostridioides difficile Infection Testing Among Hospitalized Patients

2020 ◽  
Vol 115 (1) ◽  
pp. S621-S621
Author(s):  
Ellen Axenfeld ◽  
William G. Greendyke ◽  
Jianhua Li ◽  
Daniel Green ◽  
Susan S. Whittier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Risk factors for development of initial Clostridioides difficile infection

2021 ◽  
Vol 25 ◽  
pp. 18-22
Author(s):  
Jamie L. Wagner ◽  
Kayla R. Stover ◽  
Allison M. Bell ◽  
Katie E. Barber
Keyword(s):  
Risk Factors ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Lindsay A Petty ◽  
Valerie M Vaughn ◽  
Scott A Flanders ◽  
Twisha Patel ◽  
Anurag N Malani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Antibiotic Treatment ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Altered Mental Status ◽  
Estimating Equation ◽  
Hospitalized Patients ◽  
Clostridioides Difficile ◽  
Cord Injury ◽  
Clostridioides Difficile Infection

Abstract Background Reducing antibiotic use in patients with asymptomatic bacteriuria (ASB) has been inpatient focused. However, testing and treatment is often started in the emergency department (ED). Thus, for hospitalized patients with ASB, we sought to identify patterns of testing and treatment initiated by emergency medicine (EM) clinicians and the association of treatment with outcomes. Methods We conducted a 43-hospital, cohort study of adults admitted through the ED with ASB (February 2018–February 2020). Using generalized estimating equation models, we assessed for (1) factors associated with antibiotic treatment by EM clinicians and, after inverse probability of treatment weighting, (2) the effect of treatment on outcomes. Results Of 2461 patients with ASB, 74.4% (N = 1830) received antibiotics. The EM clinicians ordered urine cultures in 80.0% (N = 1970) of patients and initiated treatment in 68.5% (1253 of 1830). Predictors of EM clinician treatment of ASB versus no treatment included dementia, spinal cord injury, incontinence, urinary catheter, altered mental status, leukocytosis, and abnormal urinalysis. Once initiated by EM clinicians, 79% (993 of 1253) of patients remained on antibiotics for at least 3 days. Antibiotic treatment was associated with a longer length of hospitalization (mean 5.1 vs 4.2 days; relative risk = 1.16; 95% confidence interval, 1.08–1.23) and Clostridioides difficile infection (CDI) (0.9% [N = 11] vs 0% [N = 0]; P = .02). Conclusions Among hospitalized patients ultimately diagnosed with ASB, EM clinicians commonly initiated testing and treatment; most antibiotics were continued by inpatient clinicians. Antibiotic treatment was not associated with improved outcomes, whereas it was associated with prolonged hospitalization and CDI. For best impact, stewardship interventions must expand to the ED.

scholarly journals 1498. Assess Risk Factors, Mortality, and Healthcare Utilization Associated with Clostridioides difficile Infection (CDI) in 4 Latin American Countries

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S545-S545
Author(s):  
Holly Yu ◽  
Nestor Flaster ◽  
Adrian Casanello ◽  
Daniel Curcio
Keyword(s):  
Risk Factors ◽  
Latin America ◽  
Hospital Admission ◽  
Healthcare Utilization ◽  
Latin American ◽  
Conditional Logistic Regression ◽  
Developed Countries ◽  
Hospital Death ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background In contrast to Europe and North America, little is known about Clostridioides difficile infection (CDI) in Latin America, especially about risk factors, mortality, and healthcare utilization. Methods We conducted a retrospective, case–control study at eight hospital centers in Brazil, Mexico, Argentina, and Chile. Hospital databases and medical records were used to identify nosocomial CDI cases from January 1, 2014 to December 31, 2017. CDI cases were patients with diarrhea and a positive CDI testing ≥72 hours after hospital admission. Two controls with no CDI diagnosis and diarrhea were matched to each CDI case and were required to (1) have a length of hospital stay (LOS) ≥ 3 days, (2) be admitted ±14 days from the case, and (3) share the same ward. Risk factors associated with CDI were assessed by conditional logistic regression. Mortality and healthcare utilization were compared between cases and controls. Results A total of 1,443 patients (≥18 years old) who met eligibility criteria were selected (481 cases and 962 controls). Comparing cases to controls, the mean age and gender representation were similar (age: 58.7 vs. 56.7 years, P = 0.269; male: 56.3% vs. 53.4%, P = 0.293), but comorbidity was higher (mean Charlson Comorbidity index: 4.3 vs. 3.6, p Conclusion Antibiotic exposure, existing medical conditions, and recent hospital admission are CDI major risk factors in Latin America. CDI also increased in-hospital death risk and LOS. These findings are consistent with published literature in developed countries. Disclosures All authors: No reported disclosures.

Hospital acquired Clostridioides difficile infection and risk factors for severity in a university hospital: A prospective study

2020 ◽  
Vol 48 (12) ◽  
pp. 1426-1430
Author(s):  
Hüseyin Bilgin ◽  
Elvan Sayın ◽  
Hande Perk Gürün ◽  
Elif Tükenmez-Tigen ◽  
Nurver Ülger Toprak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
University Hospital ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
A Prospective Study ◽  
Hospital Acquired

scholarly journals Risk Factors for BI/NAP1/027 Clostridioides difficile Infections and Clinical Outcomes Compared With Non-NAP1 Strains

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Nandita S Mani ◽  
John B Lynch ◽  
Ferric C Fang ◽  
Jeannie D Chan
Keyword(s):  
Risk Factors ◽  
Proton Pump Inhibitor ◽  
Clinical Outcomes ◽  
Case Control ◽  
Nursing Facilities ◽  
Single Center ◽  
Retrospective Case ◽  
Skilled Nursing ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract We aim to describe the characteristics, risk factors, and clinical outcomes associated with NAP1 strain Clostridioides difficile infection (CDI) in this single-center, retrospective, case–control (1:1) study. We found that the NAP1 strain accounted for 19.7% of CDI, and risk factors for acquisition included residence in skilled nursing facilities, previous CDI, and proton pump inhibitor use.

scholarly journals Clostridioides difficile infection in patients with end stage renal disease. Is it preventable?

2020 ◽  
pp. 11-21
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Significant Risk ◽  
Medical Personnel ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Stage Renal Disease ◽  
End Stage ◽  
Healthcare Associated

Clostridioides difficile infection (CDI) is a leading cause of a healthcare-associated diarrhea worldwide. Recently, an increased number of new cases and growing mortality due to CDI have been observed. Patients suffering from end-stage renal disease (ESRD) are most exposed to CDI. It has been proven that CDI in patients receiving renal replacement therapy (RRT) significantly increases mortality, prolongs hospitalization and increases the cost of treatment. Important risk factors of CDI in ERSD patients include hospitalization or stay in an intensive care unit in the last 90 days, HIV infection, bacteremia, prolonged antibiotic therapy and hypoalbuminemia. Cirrhosis, age over 65 years, hypoalbuminemia, longer hospitalization time and use of antibiotics are significant risk factors of death. Effective methods of preventing CDI include hand hygiene with soap and water, isolation of infected patients in a private room with a dedicated toilet, the use of masks, gloves, disinfection of the environment and systematic education and control of medical personnel, as well as rational antibiotic policy. In addition, it is important to avoid antibiotics with a proven risk of CDI, caution use of proton pump inhibitors (PPI) and H2 receptor antagonists. It is also important in the prevention of CDI in people with ERSD, to apply a fast diagnostic since the onset of the first symptoms. The use of probiotics and bile acids in the primary prevention of CDI requires further research. It seems that knowledge of these factors and methods of prevention will significantly reduce morbidity and mortality due to CDI.

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