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Incidence and Risk Factors for Community and Hospital Acquisition of Clostridium difficile Infection in the Tel Aviv Sourasky Medical Center

Published online by Cambridge University Press:  31 May 2017

Wasef Na’amnih ,
Amos Adler ,
Tamar Miller-Roll ,
Dani Cohen  and
Yehuda Carmeli
Wasef Na’amnih*
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Israel Center for Disease Control, Ministry of Health, Tel Hashomer, 52621, Israel; Gertner Institute, Sheba Medical Center, Tel Hashomer 52621, Israel (wasef.nhamih@icdc.health.gov.il)
Amos Adler
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
Tamar Miller-Roll
Affiliation:
Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
Dani Cohen
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
Yehuda Carmeli
Affiliation:
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel Department of Epidemiology and Preventive Medicine, Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel
*
Address correspondence to W. Na’amnih, MSc, Israel Center for Disease Control Gertner Institute, Sheba Medical Center, Tel Hashomer 52621, Israel (wasef.nhamih@icdc.health.gov.il).
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Abstract

OBJECTIVES

To estimate the incidence and identified risk factors for community-acquired (CA) and hospital-acquired (HA) Clostridium difficile infection (CDI)

METHODS

We conducted 2 parallel case-control studies at Tel Aviv Sourasky Medical Center from January 1, 2011, to December 31, 2014. We identified persons with CDI, determined whether infection was community or hospital acquired, and calculated incidence rates from 2007 to 2014. We collected demographic, clinical, and epidemiological information for CDI cases and hospitalized control cases and estimated the odds ratio with 95% confidence interval using conditional logistic regression.

RESULTS

In total, 1,563 CDI cases were identified in the study. The incidence rate of CA-CDI and HA-CDI increased by 1.6-fold and 1.2-fold, respectively, during 2012–2014. However, the incidence rate of CA-CDI was 0.84 per 100,000 (95% CI, 0.52–1.30), the rate for HA-CDI was 4.7 per 10,000 patient days (95% CI, 4.08–5.38), respectively, in 2014. We identified several factors as independent variables significantly associated with HA-CDI: functional disability, presence of nasogastric tube, antibiotic use, chemotherapy, infection by extended-spectrum β-lactamases, and mean of albumin values. Risk factors independently associated with CA-CDI were close contact with a family member who had been hospitalized in the previous 6 months, inflammatory bowel disease, and home density index (adjusted odds ratio, 25.7; 95% confidence interval, 3.99–165.54; P=.001).

CONCLUSIONS

The identification of the main modifiable risk factors for HA-CDI (antibiotic exposure and hypoalbuminemia) and for CA-CDI (close contact with a family member who had been hospitalized in the previous 6 months) is likely to optimize prevention efforts; these factors are critical in preventing the spread of CDI.

Infect Control Hosp Epidemiol 2017;38:912–920

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 912 - 920
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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