Skip to main content Accessibility help
×
Home

Spatiotemporal clustering of in-hospital Clostridioides difficile infection

  • Shreyas Pai (a1), Philip M. Polgreen (a2), Alberto Maria Segre (a1), Daniel K. Sewell (a3), Sriram V. Pemmaraju (a1) and for the CDC MInD-Healthcare group...

Abstract

Objective:

To determine whether Clostridioides difficile infection (CDI) exhibits spatiotemporal interaction and clustering.

Design:

Retrospective observational study.

Setting:

The University of Iowa Hospitals and Clinics.

Patients:

This study included 1,963 CDI cases, January 2005 through December 2011.

Methods:

We extracted location and time information for each case and ran the Knox, Mantel, and mean and maximum component size tests for time thresholds (T = 7, 14, and 21 days) and distance thresholds (D = 2, 3, 4, and 5 units; 1 unit = 5–6 m). All tests were implemented using Monte Carlo simulations, and random CDI cases were constructed by randomly permuting times of CDI cases 20,000 times. As a counterfactual, we repeated all tests on 790 aspiration pneumonia cases because aspiration pneumonia is a complication without environmental factors.

Results:

Results from the Knox test and mean component size test rejected the null hypothesis of no spatiotemporal interaction (P < .0001), for all values of T and D. Results from the Mantel test also rejected the hypothesis of no spatiotemporal interaction (P < .0003). The same tests showed no such effects for aspiration pneumonia. Our results from the maximum component size tests showed similar trends, but they were not consistently significant, possibly because CDI outbreaks attributable to the environment were relatively small.

Conclusion:

Our results clearly show spatiotemporal interaction and clustering among CDI cases and none whatsoever for aspiration pneumonia cases. These results strongly suggest that environmental factors play a role in the onset of some CDI cases. However, our results are not inconsistent with the possibility that many genetically unrelated CDI cases occurred during the study period.

Copyright

Corresponding author

Author for correspondence: Philip M. Polgreen, E-mail: Philip-polgreen@uiowa.edu

Footnotes

Hide All

PREVIOUS PRESENTATION: The work described in this manuscript was presented in part as poster #509, “Spatio-Temporal Clustering of CDI Cases at the University of Iowa Hospitals and Clinics,” at IDWeek 2018 on October 4, 2018, in San Francisco, California.

Footnotes

References

Hide All
1.Magill, SS, Edwards, JR, Bamberg, W, et al.Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
2.Evans, CT, Safdar, N. Current trends in the epidemiology and outcomes of Clostridium difficile infection. Clin Infect Dis 2015;60 suppl 2:S66S71.
3.Kwon, JH, Olsen, MA, Dubberke, ER. The morbidity, mortality, and costs associated with Clostridium difficile infection. Infect Dis Clin N Am 2015;29:123134.
4.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Healthcare costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346353.
5.Stevens, V, Dumyati, G, Fine, LS, Fisher, SG, van Wijngaarden, E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis 2011;53:4248.
6.Brown, KA, Khanafer, N, Daneman, N, Fisman, DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013;57:23262332.
7.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409415.
8.Pepin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005;173:10371042.
9.Campbell, RR, Beere, D, Wilcock, GK, Brown, EM. Clostridium difficile in acute and long-stay elderly patients. Age Ageing 1988;17:333336.
10.Howell, MD, Novack, V, Grgurich, P, et al.Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010;170:784790.
11.Dubberke, ER, Reske, KA, Olsen, MA, et al.Evaluation of Clostridium difficile–associated disease pressure as a risk factor for C. difficile–associated disease. Arch Intern Med 2007;167:10921097.
12.Miller, AC, Polgreen, LA, Cavanaugh, JE, Polgreen, PM. Hospital Clostridium difficile infection (CDI) incidence as a risk factor for hospital-associated CDI. Am J Infect Control 2016;44:825829.
13.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J, Jr . Clostridium difficile–associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.
14.Kim, KH, Fekety, R, Batts, DH, et al.Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:4250.
15.Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, Donskey, CJ. Clostridium difficile skin contamination in patients with C. difficile–associated disease. Clin Infect Dis 2008;46:447450.
16.Sethi, AK, Al-Nassir, WN, Nerandzic, MM, Bobulsky, GS, Donskey, CJ. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol 2010;31:2127.
17.Landelle, C, Verachten, M, Legrand, P, Girou, E, Barbut, F, Brun-Buisson, C. Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection. Infect Control Hosp Epidemiol 2014;35:1015.
18.Shrestha, SK, Sunkesula, VC, Kundrapu, S, Tomas, ME, Nerandzic, MM, Donskey, CJ. Acquisition of Clostridium difficile on hands of healthcare personnel caring for patients with resolved C. difficile infection. Infect Control Hosp Epidemiol 2016;37:475477.
19.Shaughnessy, MK, Micielli, RL, DePestel, DD, et al.Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201206.
20.McDonald, LC, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1e48.
21.Eyre, DW, Cule, ML, Wilson, DJ, et al.Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:11951205.
22.Tschudin–Sutter, S, Carroll, KC, Tamma, PD, et al.Impact of toxigenic Clostridium difficile colonization on the risk of subsequent C. difficile infection in intensive care unit patients. Infect Control Hosp Epidemiol 2015;36:13241329.
23.Bruminhent, J, Wang, ZX, Hu, C, et al.Clostridium difficile colonization and disease in patients undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transpl 2014;20:13291334.
24.Smith, CM, Le Comber, SC, Fry, H, Bull, M, Leach, S, Hayward, AC. Spatial methods for infectious disease outbreak investigations: systematic literature review. Euro Surveill 2015;20.
25.Curtis, DE, Hlady, CS, Kanade, G, Pemmaraju, SV, Polgreen, PM, Segre, AM. Healthcare worker contact networks and the prevention of hospital-acquired infections. PloS One 2013;8:e79906.
26.Knox, G. The detection of space–time interactions. Applied Statistics 1964;13:2529.
27.Takaguchi, T, Masuda, N, Holme, P. Bursty communication patterns facilitate spreading in a threshold-based epidemic dynamics. PloS One 2013;8:e68629.
28.Akbarpour, M, Jackson, MO. Diffusion in networks and the virtue of burstiness. Proc Nat Acad Sci U S A 2018;115:e6996e7004.
29.Cao, J. Th size of the connected components of excursion sets of X2, t and F fields. Adv in Appl Prob 1999;31:579595.
30.Mantel, N. The detection of disease clustering and a generalized regression approach. Cancer Res 1967;27:209220.
31.Bartlett, JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin N Am 2013;27:149155.
32.Ottosen, J, Evans, H. Pneumonia: challenges in the definition, diagnosis, and management of disease. Surg Clin N Am 2014;94:13051317.
33.Bowerman, TJ, Zhang, J, Waite, LM. Antibacterial treatment of aspiration pneumonia in older people: a systematic review. Clin Intervent Aging 2018;13:22012213.
34.Polgreen, PM, Yang, M, Bohnett, LC, Cavanaugh, JE. A time-series analysis of Clostridium difficile and its seasonal association with influenza. Infect Control Hosp Epidemiol 2010;31:382387.
35.Stiller, A, Salm, F, Bischoff, P, Gastmeier, P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016;5:51.
36.Dettenkofer, M, Seegers, S, Antes, G, Motschall, E, Schumacher, M, Daschner, FD. Does the architecture of hospital facilities influence nosocomial infection rates? A systematic review. Infect Control Hosp Epidemiol 2004;25:2125.
37.Rexach, CE, Tang-Feldman, YJ, Cohen, SH. Spatial and temporal analysis of Clostridium difficile infection in patients at a pediatric hospital in California. Infect Control Hosp Epidemiol 2005;26:691696.
38.Hornbeck, T, Naylor, D, Segre, AM, Thomas, G, Herman, T, Polgreen, PM. Using sensor networks to study the effect of peripatetic healthcare workers on the spread of hospital-associated infections. J Infect Dis 2012;206:15491557.
Type Description Title
WORD
Supplementary materials

Pai et al. supplementary material
Pai et al. supplementary material

 Word (83 KB)
83 KB

Spatiotemporal clustering of in-hospital Clostridioides difficile infection

  • Shreyas Pai (a1), Philip M. Polgreen (a2), Alberto Maria Segre (a1), Daniel K. Sewell (a3), Sriram V. Pemmaraju (a1) and for the CDC MInD-Healthcare group...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.