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Developing a Clinical Prediction Rule for First Hospital-Onset Clostridium difficile Infections: A Retrospective Observational Study

Published online by Cambridge University Press:  28 April 2016

Anne Press ,
Benson S Ku ,
Lauren McCullagh ,
Lisa Rosen ,
Safiya Richardson  and
Thomas McGinn
Anne Press*
Affiliation:
Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
Benson S Ku
Affiliation:
Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
Lauren McCullagh
Affiliation:
Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
Lisa Rosen
Affiliation:
Feinstein Institute for Medical Research, Manhasset, New York
Safiya Richardson
Affiliation:
Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
Thomas McGinn
Affiliation:
Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
*
Address correspondence to Anne Press, BS, Hofstra North Shore-LIJ School of Medicine, 300 Community Dr, Manhasset, NY 11030 (anniepress@gmail.com).
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Abstract

BACKGROUND

The healthcare burden of hospital-acquired Clostridium difficile infection (CDI) demands attention and calls for a solution. Identifying patients’ risk of developing a primary nosocomial CDI is a critical first step in reducing the development of new cases of CDI.

OBJECTIVE

To derive a clinical prediction rule that can predict a patient’s risk of acquiring a primary CDI.

DESIGN

Retrospective cohort study.

SETTING

Large tertiary healthcare center.

PATIENTS

Total of 61,482 subjects aged at least 18 admitted over a 1-year period (2013).

INTERVENTION

None.

METHODS

Patient demographic characteristics, evidence of CDI, and other risk factors were retrospectively collected. To derive the CDI clinical prediction rule the patient population was divided into a derivation and validation cohort. A multivariable analysis was performed in the derivation cohort to identify risk factors individually associated with nosocomial CDI and was validated on the validation sample.

RESULTS

Among 61,482 subjects, CDI occurred in 0.46%. CDI outcome was significantly associated with age, admission in the past 60 days, mechanical ventilation, dialysis, history of congestive heart failure, and use of antibiotic medications. The sensitivity and specificity of the score, in the validation set, were 82.0% and 75.7%, respectively. The area under the receiver operating characteristic curve was 0.85.

CONCLUSION

This study successfully derived a clinical prediction rule that will help identify patients at high risk for primary CDI. This tool will allow physicians to systematically recognize those at risk for CDI and will allow for early interventional strategies.

Infect Control Hosp Epidemiol 2016;37:896–900

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 896 - 900
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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