Background: Antibiotics are the crucial risk factor for Clostridium difficile infection (CDI) whether they are assessed at the level of the individual patient or the hospital ward. We tested whether receipt of antibiotics by a patient in a given hospital bed was associated with increased risk for CDI in future patients who occupy the same bed.
Methods: Adult patient pairs were included if both patients were admitted to any one of four hospitals from 2010-2015. Patient pairs were excluded if the first patient in the bed occupied it for less than 24 hours, if the second patient in the bed developed CDI within 48 hours after room admission, or if the second patient had less than 48 hours of follow-up time. The primary exposure was receipt of antibiotics in the first patient and the primary outcome was incident CDI in the second patient, defined as a positive stool PCR for toxin B and subsequent treatment for CDI. We followed the second patient for CDI for up to 14 days or until discharge or death and analyzed the data using Cox proportional hazards modeling.
Results: We analyzed 100,617 patient pairs including 576 pairs (0.6%) in which the second patient developed CDI. Receipt of antibiotics by the first patient was associated with increased risk for CDI in the next patient to occupy the same bed (Figure). This relationship remained unchanged after adjusting for the main factors known to influence risk for CDI including receipt of antibiotics in the second patient (aHR 1.36, 95% CI 1.15-1.61). This relationship also remained unchanged after excluding 1,350 pairs where the first patient developed CDI (aHR 1.35, 95% CI 1.14-1.60). Factors related to the second patient that were associated with increased risk for CDI included age over 70, increased serum creatinine, decreased albumin, acid suppression, immunosuppression, and antibiotics (aHR 4.19, 95% CI 3.51-5.01). Aside from antibiotics, no other factors related to the first patient were associated with increased risk for CDI in the second patient.
Conclusion: Receipt of antibiotics by the first patient in a given hospital bed was associated with increased risk for CDI in the next patient to occupy the same bed. Current approaches for preventing patient-to-patient transmission of C. difficile are inadequate.
B. Cohen, None
J. Abrams, None
E. Larson, None