2067. Healthcare facility-Associated Clostridium difficile Infection in Hospitalized Patients Receiving Intravenous Beta-Lactam Antibiotics in the Veterans Affairs Healthcare System (VHA)
Session: Poster Abstract Session: Clostridium difficile: Epidemiology
Saturday, October 29, 2016
Room: Poster Hall

Background: Antibiotic exposure in the intestinal tract is the most important risk factor for Clostridium difficile infection (CDI).  Oral administration of beta-lactamase enzymes has been shown to be effective in eliminating the portion of intravenous beta-lactam antibiotics that is excreted into the intestinal tract, thereby preserving the microbiota during therapy.  Development of such enzymes requires understanding the patterns of use of beta-lactams and the frequency of healthcare facility-associated (HCFA)-CDI associated with them given alone or in combination with other classes of antibiotics. 

Methods: Using nationwide databases, we determined the frequency of prescription of systemic antibiotics for all acute care hospitalizations in the VHA from 2012-2014.  The rate of HCFA-CDI (cases per hospitalization) was calculated for any antibiotic treatment and by selected beta-lactam and fluoroquinolone (FLQ) agents.     

Results: Of 1,077,559 hospitalizations among >760,000 patients, 544,541 (51%) included treatment with 1 or more systemic antibiotics, including 423,552 (39%) treated with 1 or more of the beta-lactam or FLQ agents studied (Table).  HCFA-CDI occurred in 1.2% of all hospitalizations that included treatment with systemic antibiotics versus 0.14% of hospitalizations that did not include antibiotic therapy (P<0.001).  The rate of HCFA-CDI was higher when stays included multiple antibiotics, both FLQ and beta-lactams, and ceftriaxone or cefepime versus cefazolin (Table and Figure). 

Conclusion: The beta-lactam agents studied were prescribed in nearly a quarter of analyzed hospitalizations and were frequently associated with HCFA-CDI.  Interventions that prevent disruption of the intestinal microbiota associated with these agents could have a significant impact on rates of HCFA-CDI. 



Table. Antibiotic prescriptions and HCFA-CDI in the Veterans Affairs Healthcare System from 2012 through 2014


Figure.  Frequency of HCFA-CDI associated with different antibiotic exposures, stratified by hospital versus community onset

Brigid Wilson, PhD1, Federico Perez, MD1, Elie Saade, MD, MPH2 and Curtis J. Donskey, MD3, (1)Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (2)Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, (3)Infectious Diseases, Case Western Reserve University, Cleveland, OH


B. Wilson, None

F. Perez, None

E. Saade, None

C. J. Donskey, None

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