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Association Between High-Risk Medication Usage and Healthcare Facility-Onset C. difficile Infection

Published online by Cambridge University Press:  21 April 2016

Julie A. Patterson ,
Michael B. Edmond ,
Samuel F. Hohmann  and
Amy L. Pakyz
Julie A. Patterson
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Richmond, Virginia
Michael B. Edmond
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Samuel F. Hohmann
Affiliation:
University Health System Consortium, Chicago, Illinois
Amy L. Pakyz*
Affiliation:
Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University Richmond, Virginia
*
Address correspondence to Amy L. Pakyz, PharmD, MS, PhD, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Box 980533 (apakyz@vcu.edu).
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Abstract

OBJECTIVE

National hospital performance measures for C. difficile infection (CD) are available; comparing antibacterial use among performance levels can aid in identifying effective antimicrobial stewardship strategies to reduce CDI rates.

DESIGN

Hospital-level, cross-sectional analysis.

METHODS

Hospital characteristics (ie, demographics, medications, patient mix) were obtained for 77 hospitals for 2013. Hospitals were assigned 1 of 3 levels of a CDI standardized infection ratio (SIR): ‘Worse than,’ ‘Better than,’ or ‘No different than’ a national benchmark. Analyses compared medication use (total and broad-spectrum antibacterials) for 3 metrics: days of therapy per 1,000 patient days; length of therapy; and proportion of patients receiving a medication across SIR levels. A multivariate, ordered-probit regression identified characteristics associated with SIR categories.

RESULTS

Regarding total average antimicrobial use per patient, there was a significant difference detected in mean length of therapy: ‘No different’ hospitals having the longest (4.93 days) versus ‘Worse’ (4.78 days) and ‘Better’ (4.43 days) (P<.01). ‘Better’ hospitals used fewer total antibacterials (693 days of therapy per 1,000 patient days) versus ‘No different’ (776 days) versus ‘Worse’ (777 days) (P<.05). The ‘Better’ hospitals used broad-spectrum antibacterials for a shorter average length of therapy (4.03 days) versus ‘No different’ (4.51 days) versus ‘Worse’ (4.38 days) (P<.05). ‘Better’ hospitals used fewer broad-spectrum antibacterials (310 days of therapy per 1,000 patient days) versus ‘No different’ (364 days) versus ‘Worse’ (349 days) (P<.05). Multivariate analysis revealed that the proportion of elderly patients and chemotherapy days of therapy per 1,000 patient days was significantly negatively associated with the SIR.

CONCLUSIONS

These findings have potential implications regarding the need to fully account for hospital patient mix when carrying out inter-hospital comparisons of CDI rates.

Infect Control Hosp Epidemiol 2016;37:909–915

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 909 - 915
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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