scholarly journals Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

2018 ◽  
Vol 39 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Anthony D. Harris ◽  
Alyssa N. Sbarra ◽  
Surbhi Leekha ◽  
Sarah S. Jackson ◽  
J. Kristie Johnson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Gastric Acid ◽  
Antibiotic Use ◽  
Acid Suppression ◽  
Comorbid Conditions ◽  
Acid Suppression Therapy ◽  
Multivariable Regression ◽  
Comorbidity Index ◽  
Gastric Acid Suppression

OBJECTIVETo analyze whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use.PATIENTSPatients aged ≥18 years admitted to the University of Maryland Medical Center between November 7, 2015, and May 31, 2017.METHODSComorbid conditions were assessed using the Elixhauser comorbidity index. The Elixhauser comorbidity index and the comorbid condition components were calculated using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes extracted from electronic medical records. Bivariate associations between CDI and potential covariates for multivariable regression, including antibiotic use, gastric acid suppression therapy use, as well as comorbid conditions, were estimated using log binomial multivariable regression.RESULTSAfter controlling for antibiotic use, age, proton-pump inhibitor use, and histamine-blocker use, the Elixhauser comorbidity index was a significant risk factor for predicting CDI. There was an increased risk of 1.26 (95% CI, 1.19–1.32) of having CDI for each additional Elixhauser point added to the total Elixhauser score.CONCLUSIONSAn increase in Elixhauser score is associated with CDI. Our study and other studies have shown that comorbid conditions are important risk factors for CDI. Electronically available comorbid conditions and scores like the Elixhauser index should be considered for risk-adjustment of CDC CDI rates.Infect Control Hosp Epidemiol 2018;39:297–301

scholarly journals 2370. Risk Factors for Clostridioides difficile Colonization Among Adult Inpatients: A Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S817-S818
Author(s):  
Adam M Brown ◽  
Scott Anjewierden ◽  
Abhishek Deshpande
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Gastric Acid ◽  
Meta Analysis ◽  
The United States ◽  
Adult Patients ◽  
Acid Suppression ◽  
Clostridioides Difficile ◽  
Acid Suppression Therapy ◽  
Gastric Acid Suppression

Abstract Background Clostridioides difficile is one of the most common causes of healthcare-associated infections in the United States. The prevalence of asymptomatic C. difficile colonization has been demonstrated to range from 3 to 21% for hospitalized adults. Patients colonized with C. difficile may serve as potential reservoirs for transmission of C. difficile infection (CDI) within inpatient units. The purpose of this meta-analysis was to identify the risk factors for colonization at hospital admission among adult patients, to inform strategies for infection prevention. Methods We searched MEDLINE, Scopus, Web of Science, and Embase from inception to 2019 for articles related to C. difficile colonization on hospital admission. Studies with multivariate analyses evaluating risk factors for asymptomatic colonization in adult inpatients were eligible. Odds ratios were pooled using a random effects model. Study quality and publication bias analyses were also conducted. Results Among 2,982 studies identified in the search, 21 studies met the inclusion criteria. Included studies reported 18,468 adult patients of which 1,243 were asymptomatically colonized with C.difficile. Factors associated with an increased risk of colonization were CDI in the last 3 months (OR 4.18, 95% CI 2.56–6.82, I2 = 0%), hospitalization in the last 6 months (OR 2.45, 95% CI 2.06–2.92, I2 = 0%) and use of gastric acid suppression therapy within the last 8 weeks (OR 1.46, 95% CI 1.17–1.73, I2 = 1%). Receipt of antibiotics in the last 3 months (OR 1.37, 95% CI 0.94–2.01, I2 = 48%) and use of non-steroidal anti-inflammatory drugs (OR 0.90, 95% CI 0.52–1.55, I2 = 65%) were not associated with statistically significant effects on risk of colonization. There were insufficient studies to determine the association between most antibiotic classes and the risk of colonization. Conclusion C.difficile colonization on hospital admission was significantly associated with previous CDI, recent hospitalization, and gastric acid suppression therapy. Recognition of these risk factors may assist in identifying potential carriers of C. difficile. These findings also emphasize the importance of judicious use of gastric acid suppression and other preventative measures in reducing C. difficile acquisition. Disclosures All authors: No reported disclosures.

Risk factors for Clostridioides difficile colonization among hospitalized adults: A meta-analysis and systematic review

2020 ◽  
pp. 1-8
Author(s):  
Scott Anjewierden ◽  
Zheyi Han ◽  
Adam M. Brown ◽  
Curtis J. Donskey ◽  
Abhishek Deshpande
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Gastric Acid ◽  
Meta Analysis ◽  
Tube Feeding ◽  
Acid Suppression ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Acid Suppression Therapy ◽  
Gastric Acid Suppression

Abstract Objective: To identify risk factors for asymptomatic Clostridioides difficile colonization among hospitalized adults utilizing a meta-analysis, which may enable early identification of colonized patients at risk of spreading C. difficile. Design: Meta-analysis and systematic review. Methods: We systematically searched MEDLINE, Scopus, Web of Science, and EMBASE from January 1, 1975, to February 15, 2020, for articles related to C. difficile colonization among hospitalized adults. Studies with multivariable analyses evaluating risk factors for asymptomatic colonization were eligible. Results: Among 5,506 studies identified in the search, 19 studies met the inclusion criteria. Included studies reported 20,334 adult patients of whom 1,588 were asymptomatically colonized with C. difficile. Factors associated with an increased risk of colonization were hospitalization in the previous 6 months (OR, 2.18; 95% CI, 1.86–2.56; P < .001), use of gastric acid suppression therapy within the previous 8 weeks (OR, 1.42; 95% CI, 1.17–1.73; P < .001), tube feeding (OR, 2.02; 95% CI, 1.06–3.85; P = .03), and corticosteroid use in the previous 8 weeks (OR, 1.58; 95% CI, 1.14–2.17; P = .006). Receipt of antibiotics in the previous 3 months (OR, 1.37; 95% CI, 0.94–2.01; P = .10) was not associated with statistically significant effects on risk of colonization. Conclusions: C. difficile colonization was significantly associated with previous hospitalization, gastric acid suppression, tube feeding, and corticosteroid use. Recognition of these risk factors may assist in identifying asymptomatic carriers of C. difficile and taking appropriate measures to reduce transmission.

scholarly journals Inappropriate Use of Gastric Acid Suppression Therapy in Hospitalized Patients with Clostridium difficile—Associated Diarrhea: A Ten-Year Retrospective Analysis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Sadat Rashid ◽  
Dhyan Rajan ◽  
Javed Iqbal ◽  
Seth Lipka ◽  
Robin Jacob ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Gastric Acid ◽  
Retrospective Analysis ◽  
Practice Guidelines ◽  
Hospitalized Patients ◽  
Acid Suppression ◽  
Inappropriate Use ◽  
Acid Suppression Therapy ◽  
Additional Approach ◽  
Gastric Acid Suppression

Purpose. The incidence of Clostridium difficile-associated diarrhea (CDAD) has steadily increased over the past decade. A multitude of factors for this rise in incidence of CDAD have been postulated, including the increased use of gastric acid suppression therapy (GAST). Despite the presence of practice guidelines for use of GAST, studies have demonstrated widespread inappropriate use of GAST in hospitalized patients. We performed a retrospective analysis of inpatients with CDAD, with special emphasis placed on determining the appropriateness of GAST. Methods. A retrospective analysis was conducted at a multidisciplinary teaching hospital on inpatients with CDAD over a 10-year period. We assessed the use of GAST in the cases of CDAD. Data collection focused on the appropriate administration of GAST as defined by standard practice guidelines. Results. An inappropriate indication for GAST was not apparent in a majority (69.4%) of patients with CDAD. The inappropriate use of GAST was more prevalent in medical (86.1%) than on surgical services (13.9%) (P<0.001). There were more cases (67.6%) of inappropriate use of GAST in noncritical care than in critical care areas (37.4%) (P<0.001). Conclusion. Our study found that an inappropriate use of inpatient GAST in patients with CDAD was nearly 70 percent. Reduction of inappropriate use of GAST may be an additional approach to reduce the risk of CDAD and significantly decrease patient morbidity and healthcare costs.

Risk of Clostridium difficile-Associated Disease Among Patients Receiving Proton-Pump Inhibitors in a Quebec Medical Intensive Care Unit

2007 ◽  
Vol 28 (11) ◽  
pp. 1305-1307 ◽  
Author(s):  
Mathieu Beaulieu ◽  
David Williamson ◽  
Gilbert Pichette ◽  
Jean Lachaine
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Gastric Acid ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Medical Intensive Care Unit ◽  
Antibiotic Use ◽  
Medical Intensive Care

Our study was conducted to determine whether use of gastric acid-suppressive agents increased the risk of Clostridium difficile-associated disease (CDAD) in a medical intensive care unit of one of the first hospitals to be threatened by the current CDAD epidemic in Quebec, Canada. Our findings suggest that efforts to determine risk factors for CDAD should focus on other areas, such as older age and antibiotic use.

CLINICAL IMPACTS OF GASTRIC ACID SUPPRESSION THERAPY ON PATIENT WITH ADENOCARCINOMA OF LUNG TREATED WITH GEFITINIB

CHEST Journal ◽  
2019 ◽  
Vol 155 (4) ◽  
pp. 200A
Author(s):  
W.C. Kwok ◽  
J.C.M. Ho ◽  
L. David Chi Leung ◽  
M.M.S.L. Lui ◽  
M.S.M. Ip ◽  
...  
Keyword(s):  
Gastric Acid ◽  
Acid Suppression ◽  
Acid Suppression Therapy ◽  
Adenocarcinoma Of Lung ◽  
Gastric Acid Suppression
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