Program Schedule

1624
Risk Factors for Hospital-Acquired Clostridium difficile

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:

Hospital-acquired Clostridium difficile infection (HA-CDI) increases morbidity, length of stay, and hospitalization costs. Environmental contamination is suspected of increasing risk for HA-CDI, but the effect size has not been characterized. We created a risk-factor model for HA-CDI, including an indicator of whether the patient inhabited a hospital room recently occupied by a CDI case.

Methods:

All cases of HA-CDI from January 2012 through December 2013 were identified. Three inpatient controls for each case were randomly selected from the same time period. Gender, age, recent exposure to 3rd-generation cephalosporins or fluoroquinolones, recent proton pump inhibitor (PPI) exposure, and length of stay (LOS) were collected. For cases, LOS was limited to the number of days from admission to onset. After sensitivity analysis indicated likely confounding, patients with LOS greater than two standard deviations from the mean were excluded from the analysis. The room location history of each case and control was then compared with those of all cases to determine whether a patient subsequently inhabited the same hospital room as a previous case within 5 months of the previous case’s onset (‘CDI room’). Univariate analysis using the Chi-square or Wilcoxon rank-sum test assessed the association between each risk factor and HA-CDI. Logistic regression was performed for variables with univariate p-value < 0.3.

Results:

96 cases and 288 controls were identified; 90 cases and 281 controls were included in the analysis. Univariate analysis indicated that gender, LOS, and CDI room were significantly associated with HA-CDI. In multivariate logistic regression, staying in the same room as a previous CDI case was the only significant predictor of HA-CDI.

Conclusion:

Environmental contamination may be a more important factor in HA-CDI than previously thought. Effective cleaning procedures for rooms occupied by patients with CDI should be emphasized.

 

 

 

Univariate

 

Multivariate

Risk Factor

 

No CDI (n=281)

CDI (n=90)

P-value

 

OR

95% CI

CDI Room

 

57 (20)

38 (42)

<0.001

 

2.6

1.5-4.4

Recent Antibiotics

 

18 (6)

11 (12)

0.07

 

1.6

0.7-3.8

Recent PPI

 

25 (9)

12 (13)

0.22

 

1.5

0.7-3.3

Age, mean (standard deviation)

 

49 (18)

52 (17)

0.13

 

1.0

0.9-1.0

Male

 

132 (47)

56 (62)

0.01

 

1.6

0.9-2.7

LOS, mean (standard deviation)

 

8 (7)

10 (8)

0.001

 

1.1

0.9-1.3

 

 

 

 

 

 

 

 

Bryan Knepper, MPH, MSc, Patient Safety and Quality, Denver Health Medical Center, Denver, CO and Connie Price, MD, Infectious Diseases, Denver Health Medical Center, Denver, CO

Disclosures:

B. Knepper, None

C. Price, None

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.

Sponsoring Societies:

© 2014, idweek.org. All Rights Reserved.

Follow IDWeek