Multicentre derivation and validation of a simple predictive index for healthcare-associated Clostridium difficile infection

Abstract

We developed a predictive index for 30-day risk of healthcare-associated CDI using readily available and clinically useful variables. This simple predictive risk index may be used to improve clinical decision making and resource allocation for CDI stewardship initiatives, and guide research design.

Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective

“…In the model, the use of guidelineconcordant CABP inpatient treatments (i.e., fluoroquinolones and ceftriaxone) was replaced with omadacycline. The underlying model assumptions were: (1) CDI rates in hospitals can be reduced by limiting the use of broad-spectrum antibiotics such as fluoroquinolones and ceftriaxone [20,[26][27][28], (2) omadacycline has a lower propensity to induce CDI relative to current guideline-concordant inpatient CABP treatments [1][2][3][4][5][6][7][21][22][23], and (3) omadacycline has the potential to minimize CDI events [21,25]. For the study population, it is estimated that 1 million adult patients in the United States of America are hospitalized with suspected or documented CABP annually [17] and 10% of CABP admissions occur in patients with a DRS ≥ 6 [3,21] (Table 1).…”

“…Infections due to Clostridioides difficile (CDI), a common adverse effect associated with use of board-spectrum antibiotic therapy [1][2][3][4][5][6][7], is a leading cause of healthcare-associated infections. Such infections cause an estimated 2.24 cases per 1000 hospital admissions per year [8].…”

“…However, most CDI-risk reduction initiatives are aimed at secondary prevention. Given that use of broad-spectrum antibiotics, in large part, drive healthcare-associated CDI (HCA-CDI) rates [1][2][3][4][5][6], there is need to proactively use validated CDI risk stratification tools such as the Davis risk score (DRS) [3] to minimize the use of high CDI risk antibiotics [16], such as fluoroquinolones and ceftriaxone, in high-CDI-risk patients as a primary HCA-CDI prevention measure.…”

“…Data suggest that there are approximately 1 million CABP admissions per year in the United States of America [17] and approximately 3% of patients hospitalized with suspected or documented CABP develop CDI [18]. Despite their increased propensity to cause CDIs, especially in patients at an increased risk of developing CDI, third-generation cephalosporins and fluoroquinolones continue to be the preferred first-line agents for hospitalized patients with suspected or documented CABP [1][2][3][4][5][6][7]16,19]. In a recent real-world evidence study, hospitalized CABP patients who received ceftriaxone plus azithromycin, one of the mostly used guidelineconcordant CABP treatment regimens, were at substantially higher odds of developing HCA-CDI relative to other treatments [20].…”

“…In the phase 3 OPTIC study that compared omadacycline to moxifloxacin for adult hospitalized CABP patients, 2% of CABP patients who received moxifloxacin developed CDI versus 0% for omadacycline [21]. Among patients in the phase 3 OPTIC study with a Davis risk score (DRS) ≥ 6 [3] (one of the most well-described predictive indices for 30-day risk of HCA-CDI), 14% of CABP patients treated with moxifloxacin developed CDI compared with no patients in the omadacycline-treated group, despite balanced CDI risks between treatment groups [25]. To better understand the economic implications of targeted substitution of current guideline-concordant CABP inpatients treatments (i.e., fluoroquinolones and ceftriaxone) with omadacycline in adult CABP inpatients with a DRS ≥ 6 [3], a US decision analytic healthcare model from the hospital perspective was developed.…”