1038. Evaluating Antibiotic Use and Recurrent CDI Risk Among Hospitalized Patients with a History of Clostridium Difficile Infection: Opportunities in Stewardship
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall

Background:  The national epidemic of C. difficile infection (CDI) urges attentiveness to judicious antibacterial use. Patients with a history of CDI are at high risk for recurrent CDI and a prime target for antibiotic stewardship. We examined appropriateness of antibiotics prior to recurrence and repeat antibiotic use as a risk factor for recurrent CDI.

Methods:  In this retrospective cohort study, we evaluated all patients with a history of CDI admitted for any reason to an academic medical center in 2014.  Electronic health records were reviewed for: demographics, comorbidities, surgical history, immunosuppression or acid blocker use, parenteral nutrition, and infectious diseases (ID) consultation, among others.  Antibiotic use within 4 weeks of admission was evaluated retrospectively by an ID physician for appropriateness.  Logistic regression analysis was used to identify risk factors predicting recurrent CDI.

Results:  Among 212 patients admitted with a history of CDI, 54 (25.5%) developed recurrent CDI and 80% (43/54) were community-onset (< 3 days of admit).  Antibiotics were used within 4 weeks prior to admission (PTA) in 81% (44/54) of recurrent CDI compared to 55% (88/158) in non-recurrent CDI patients.  Antibiotics were inappropriate in 35.2% (19/54) of those developing recurrent CDI compared to 20.2% (32/158) of non-recurrent CDI patients.  Beta-lactam/beta-lactamase inhibitor or carbapenem use PTA was seen in 30% (16/54) of recurrent CDI patients compared to 15% (23/158) of non-recurrent CDI patients. Antibiotic use prior to admission and TPN were strongly associated with recurrent CDI after adjustment for demographics, diabetes, and acid blocker use (Table 1). ID consultation was obtained in 10.8% (23/212) of all patients reviewed. 

Conclusion: History of CDI should trigger caution in antibiotic prescription, yet our findings suggest inappropriate antibiotic usage, particularly broad-spectrum agents even in those at high risk for recurrence. Inappropriate selection or use of antibiotics was prevalent and ID consultation underutilized. Patients with a history of CDI represent an important target for antibacterial stewardship.

Jeffrey Wang, MD, University of California at Irvine School of Medicine, Orange, CA, Kathleen a. Quan, RN, MSN, CIC, 6346 Adobe Cir S, Epidemiology and Infection Prevention Program, University of California Irvine Health, Orange, CA, Thomas Tjoa, MPH, MS, Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, Jennifer Yim, RN, BSN, CIC, University of California, Irvine Medical Center, Orange, CA, Linda Dickey, RN, MPH, CIC, Epidemiology and Infection Prevention, University of California Irvine Medical Center, Orange, CA, Justin Chang, BS, School of Biological Sciences, University of California, Irvine, Glendale, CA, Susan S. Huang, MD, MPH, FIDSA, FSHEA, University of California Irvine School of Medicine, Orange, CA and Shruti K. Gohil, MD, MPH, Division of Infectious Diseases, Department of Medicine, University of California Irvine, Orange, CA

Disclosures:

J. Wang, None

K. A. Quan, None

T. Tjoa, None

J. Yim, None

L. Dickey, None

J. Chang, None

S. S. Huang, Sage Products: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
Molnlycke: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
3M: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product
Clorox: Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract) , Participating healthcare facilities in my studies received contributed product

S. K. Gohil, None

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