Decreasing Hospital- Onset Clostridium difficile Using Conventional Quality Improvement Methods

Burns, Lillian A.; Berger, Judith; Pozzuoli, Louise; Woods, Barbara

doi:10.1016/j.ajic.2017.04.154

Cited by 1 publication

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“…[22][23][24] Over 11 years, CDI incidence increased, but after stratifying rates before and after introduction of the PCR test, there was no overall trend in rates of total CDI, but a decrease in HA-CDI and an increase in CA-CDI. This downward trend in HA-CDI is consistent with recent studies 25,26 and a recent report from the CDC that described a 12% decrease of HA-CDI. 27 The increasing trend of CA-CDI incidence also is consistent with previous longitudinal studies.…”

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confidence: 92%

Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis

Song

Cohen

Zachariah

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Given recent changes in the epidemiology of Clostridioides difficile infection (CDI) and prevention efforts, we investigated temporal changes over a period of 11 years (2006–2016) in incidence and risk factors for CDI. Design: Retrospective matched case-control study. Setting/Patients: Pediatric and adult inpatients (n = 694,849) discharged from 3 hospitals (tertiary and quaternary care, community, and pediatric) in a large, academic health center in New York City. Methods: Risk factors were identified in cases and controls matched by length of stay at a ratio of 1:4. A Cochran–Armitage or Mann-Kendall test was used to investigate trends of incidence and risk factors. Results: Of 694,849 inpatients, 6,038 (0.87%) had CDI: 44% of these cases were hospital acquired (HA-CDI) and 56% were community acquired (CA-CDI). We observed temporal downward trends in HA-CDI (−0.03% per year) and upward trends in CA-CDI (+0.04% per year). Over time, antibiotics were administered to more patients (+3% per year); the use of high-risk antibiotics declined (–1.2% per year); and antibiotic duration increased in patients with HA-CDI (+4.4% per year). Fewer proton-pump inhibitors and more histamine-2 blockers were used (−3.8% and +7.3% per year, respectively; all Ptrend <.05). Conclusions: Although the incidence of HA-CDI decreased over time, CA-CDI simultaneously increased. Continued efforts to assure judicious use of antibiotics in inpatient and community settings is clearly vital. Measuring the actual the level of exposure of an antibiotic (incidence density) should be used for ongoing surveillance and assessment.

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