S1136 Healthcare Burden and Impact of Clostridioides difficile Infection Among Liver Cirrhosis Hospitalizations in the United States From 2003 to 2017

Abstract Background In 2009, the Centers for Disease Control and Prevention (CDC) implemented Clostridioides difficile infection (CDI) surveillance through the Emerging Infections Program (EIP) to monitor the incidence and evolving epidemiology of CDI in the United States. Since 2012, ribotypes (RTs) 027, 106, 002, 014, and 020 have constituted the top five strain types among both US community- and healthcare-associated isolates. Here we describe the changes in molecular epidemiology of C. difficile isolates collected in the United States in 2017. Methods In 2017, CDI surveillance was conducted at 10 EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, and TN). A convenience sample of clinical laboratories across EIP sites submitted C. difficile-positive stool specimens to the MN Department of Health Public Health Laboratory and Hines VA Hospital (IL) for culture. Isolates were forwarded to CDC and characterized by capillary-based PCR-ribotyping and PCR detection of tcdA, tcdB, cdtA, cdtB, and deletions in tcdC. Results In 2017, 1,051 C. difficile isolates were submitted; the total number of isolates received from each site ranged from 11 to 286 with a median of 85.5. In total, 143 RTs were observed, with the majority of isolates harboring toxin genes tcdA and tcdB (95%) and a wild-type tcdC sequence (71%). Among 556 healthcare-associated isolates, RT 027 was the most prevalent and the top RT at 5 sites (CA, GA, MD, NM, TN). Ribotype 106 was the most prevalent among 495 community-associated CA isolates and the top RT at 6 sites (CO, CT, GA, MD, MN, TN). Ribotype 027 significantly decreased from 2012 to 2017 among both healthcare-associated (21% vs 15%; p = 0.02) and community-associated isolates (17% vs 6%; P < 0.0001). Among healthcare-associated isolates, RT 076, which was observed in 8 EIP sites, increased from 2% in 2016 to 5% in 2017 (p = 0.05) and replaced RT 020 as one of the top 5 healthcare-associated RTs in 2017. Conclusion Despite an overall decline since 2012, RT 027 remained the most prevalent RT among healthcare-associated isolates submitted in 2017. The increased frequency of RT 076 among healthcare-associated isolates submitted in 2017 highlights the evolving molecular epidemiology of C. difficile and the need for continued surveillance to monitor potential emerging strains. Disclosures All authors: No reported disclosures.

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S173 Fecal Microbiota Transplantation and Clostridioides difficile Infection Among Privately Insured Patients in the United States

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000773164.25227.ae ◽

2021 ◽

Vol 116 (1) ◽

pp. S76-S77

Author(s):

Jessica El Halabi ◽

Natha P. Palmer ◽

Kathe Fox ◽

Isaac Kohane ◽

Maha R. Farhat

Keyword(s):

United States ◽

Fecal Microbiota Transplantation ◽

The United States ◽

Fecal Microbiota ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Insured Patients ◽

Privately Insured

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Association between statewide adoption of the CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs and rates of methicillin-resistant Staphylococcus aureus bacteremia and Clostridioides difficile infection in the United States

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.352 ◽

2019 ◽

Vol 41 (4) ◽

pp. 430-437

Author(s):

Alessandra B. Garcia Reeves ◽

James W. Lewis ◽

Justin G. Trogdon ◽

Sally C. Stearns ◽

David J. Weber ◽

...

Keyword(s):

United States ◽

Staphylococcus Aureus ◽

Antimicrobial Stewardship ◽

Methicillin Resistant Staphylococcus Aureus ◽

The United States ◽

The Core ◽

Staphylococcus Aureus Bacteremia ◽

Clostridioides Difficile ◽

Core Elements ◽

Clostridioides Difficile Infection

AbstractObjective:To measure the association between statewide adoption of the Centers for Disease Control and Prevention’s (CDC’s) Core Elements for Hospital Antimicrobial Stewardship Programs (Core Elements) and hospital-associated methicillin-resistant Staphylococcus aureus bacteremia (MRSA) and Clostridioides difficile infection (CDI) rates in the United States. We hypothesized that states with a higher percentage of reported compliance with the Core Elements have significantly lower MRSA and CDI rates.Participants:All US states.Design:Observational longitudinal study.Methods:We used 2014–2016 data from Hospital Compare, Provider of Service files, Medicare cost reports, and the CDC’s Patient Safety Atlas website. Outcomes were MRSA standardized infection ratio (SIR) and CDI SIR. The key explanatory variable was the percentage of hospitals that meet the Core Elements in each state. We estimated state and time fixed-effects models with time-variant controls, and we weighted our analyses for the number of hospitals in the state.Results:The percentage of hospitals reporting compliance with the Core Elements between 2014 and 2016 increased in all states. A 1% increase in reported ASP compliance was associated with a 0.3% decrease (P < .01) in CDIs in 2016 relative to 2014. We did not find an association for MRSA infections.Conclusions:Increasing documentation of the Core Elements may be associated with decreases in the CDI SIR. We did not find evidence of such an association for the MRSA SIR, probably due to the short length of the study and variety of stewardship strategies that ASPs may encompass.

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