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Characterizing Clostridioides difficile infections and hospital exposures in California using surveillance and administrative data, 2014–2015

Published online by Cambridge University Press:  30 September 2020

Monise Magro Open the ORCID record for Monise Magro [Opens in a new window] ,
Jon Rosenberg  and
Erin Epson Open the ORCID record for Erin Epson [Opens in a new window]
Monise Magro*
Affiliation:
Healthcare-Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
Jon Rosenberg
Affiliation:
Healthcare-Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
Erin Epson
Affiliation:
Healthcare-Associated Infections Program, Center for Health Care Quality, California Department of Public Health, Richmond, California
*
Author for correspondence: Monise Magro, E-mail: monise.magro@cdph.ca.gov
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Abstract

Objective:

To evaluate a method to identify hospitals contributing to Clostridioides difficile infections (CDI) at subsequent hospitalizations.

Design:

Retrospective cohort study.

Methods:

We merged 2014–2015 National Healthcare Safety Network (NHSN) inpatient CDI laboratory-identified events with hospital patient discharge data. For patients with incident community-onset CDI (CO CDI), we identified immediately preceding admissions (within 12 weeks) unrelated to CDI at different (exposure) hospitals. We calculated an exposure rate, and we selected hospitals with the highest (90th–100th percentile) rates by hospital type and compared these rates with reported standardized infection ratios (SIR) for CDI.

Results:

We successfully matched 44,691 of 58,842 NHSN CDI records (76.0%) with a hospital discharge record. Among 36,215 unique matched records, 5,234 (14.5%) had an admission not related to CDI within 12 weeks prior to an incident CO CDI event, and 1,574 of these admissions (30.1%) occurred in a different hospital. For 33 hospitals with an exposure ranking within the 90th–100th percentile, CDI SIRs for 22 (66.7%) were not significantly different; 3 (9.1%) were lower; and 8 (24.2%) were higher than the national baseline. Also, 12 (36.4%) had an SIR ≤1.0.

Conclusions:

The identification of high-ranked exposure hospitals presents an alternative to SIR for measuring the contribution of hospitals to the CDI burden across the continuum of care. Further exploration of the potential factors leading to high exposure rank, such as antibiotic use and infection control practices, is indicated and may inform CDI prevention outreach to healthcare facilities and provider networks in California and elsewhere.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 3 , March 2021 , pp. 292 - 297
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. Preliminary results of this manuscript were presented during a poster abstract session on October 4, 2018 at IDWeek, in San Francisco.

References

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