Methods: This was a retrospective cohort study conducted using the HCUP state inpatient databases (SID) for the state of California from 2005 through 2011.
For each patient’s hospital stay, we calculated the hospital's CDI incidence rate, using all CDI cases, corresponding to the patient's discharge year and quarter. Each patient’s own CDI status was excluded from this rate. HA-CDI cases were identified by CDI diagnoses coded not present on admission.
A pooled logistic regression was used to estimate risk for HA CDI: all admissions from a given patient that occurred prior to, and including, a first CDI diagnosis were treated as multiple observations. We controlled for a range of patient and hospital characteristics including age, sex, race, length of stay, previous admission, dialysis, enteral feeding, intra-abdominal or gastrointestinal procedures, mechanical ventilation, nasogastric tube insertion, chemotherapy, comorbidity indicators, hospital size, hospital-average patient age, and percentage Medicaid at the hospital.
A total of 10,329,988 patients (including 26,086 HA-CDI cases) had non-missing values for all of the risk factors analyzed.
We found the CDI incidence that a patient encountered in the hospital to be associated with a significant increase in his/her risk for CDI: a percentage point increase in the CDI incidence rate a patient encountered increased his/her odds of CDI by a factor of 1.182. As a point of comparison, a one-percentage point increase in the CDI incidence rate that patient encountered had roughly the same impact on their odds of acquiring a CDI as a 55.8-day increase in their LOS or a 60 year increase in age.
Patients treated in hospitals with a higher incidence of CDI were more likely to acquire CDI, even after controlling for a broad range of individual and institutional factors. Hospital incidence of CDI, whether community or hospital associated, may increase the likelihood of patient exposure to Clostridium difficile.
J. Cavanaugh, None
P. M. Polgreen, None
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