Program Schedule

1640
Antibiotic Use Patterns in a Population with Long Term Care-Onset C. difficile Infection Developing after Recent Hospitalization

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • ID Week Poster_Felsen.pdf (557.1 kB)
  • Background: Clostridium difficile infection (CDI) is common in the elderly due to decreased immunity and frequent antibiotic and healthcare exposure.  We investigated antibiotic use in hospitalized long term care facility (LTCF) residents that developed CDI to identify potential stewardship targets.

    Methods: CDI cases were identified by the CDC‘s Emerging Infections Program active population surveillance.  Incident cases were LTCF residents with a positive stool test within 30 days post-hospitalization and more than 8 weeks from a previous positive. Antibiotic use and readmission data were abstracted from hospital medical records.  

    Results:

    Records of 130 Monroe County, NY residents discharged from 4 acute care hospitals to 33 LTCFs were reviewed.   Thirty-one (24%) patients were readmitted to the hospital within 2 days before or 7 days after CDI.  Thirty-two (25%), 104 (80%), and 51 (39%) patients received antibiotics pre- and during hospitalization and at hospital discharge, respectively (Table 1).   Fluoroquinolones, 1st and 3rd generation cephalosporins and extended-spectrum penicillin combinations were the most common.  Common indications included lower respiratory tract infections (LRTI) and urinary tract infections (UTI); however review of the UTI cases showed that 60% of 25 non-catheterized patients did not meet the McGeer UTI criteria. 

     

    Hospitalization

     

    Pre

    During 

    At Discharge

     

    N=32

    N=104

    N=51

     

    N (%)

    n (%)

    n (%)

    No. of antibiotics

     

     

     

    1

    21 (66)

    18 (17)

    49 (96)

    2

    9 (28)

    19 (18)

    2 (4)

    ≥3

    2 (6)

    67 (64)

    0

    Common classes*

     

     

     

    Extended-spectrum penicillin combo

    1 (2)

    68 (20)

    8 (15)

    Fluoroquinolones

    10 (20)

    35 (11)

    12 (24)

    1stgen. cephalosporins

    6 (12)

    9 (3)

    13 (25)

    3rd gen. cephalosporins

    6 (12)

    15 (5)

    6 (12)

    Common indications*

     

     

     

    UTI

    11 (22)

    67 (18)

    16 (25)

    LRTI

    3 (6)

    72 (19)

    14 (22)

    Skin/Soft Tissue Infection

    8 (16)

    55 (14)

    6 (10)

    Bloodstream Infection

    4 (8)

    23 (6)

    7 (11)

    Table 1. Antibiotic Use Characteristics

    *Can be >1/resident

    Conclusion:

    LTCF residents developing CDI after acute care hospitalization had frequent antibiotic exposure prior to CDI diagnosis to treat presumed UTI and LRTI.  These antibiotics were administered before, during and at discharge from hospitalization.  This highlights the need for stewardship activities that target antibiotic usage across the continuum of care, particularly at care transition.

    Christina Felsen, MPH1, Gail Quinlan, RN, MSN1, Cathleen Concannon, MPH1, Anita Gellert, RN1, Deborah Nelson, MSN, RN1, Rebecca Tsay, MPH, MLS1, Ghinwa Dumyati, MD2 and Elizabeth Dodds-Ashley, PharmD, MHS3, (1)New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Center for Community Health, Rochester, NY, (2)Infectious Diseases, University of Rochester, Rochester, NY, (3)University of Rochester Medical Center, Rochester, NY

    Disclosures:

    C. Felsen, None

    G. Quinlan, None

    C. Concannon, None

    A. Gellert, None

    D. Nelson, None

    R. Tsay, None

    G. Dumyati, None

    E. Dodds-Ashley, Cubist Pharmaceuticals: Scientific Advisor, travel reimbursement

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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