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Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting

Published online by Cambridge University Press:  11 November 2019

Zarchi E. Sumon ,
Alan J. Lesse ,
John A. Sellick ,
Sheldon Tetewsky  and
Kari A. Mergenhagen
Zarchi E. Sumon
Affiliation:
Division of Infectious Diseases, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
Alan J. Lesse
Affiliation:
Division of Infectious Diseases, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York Veterans Affairs Western New York Healthcare System, Buffalo, New York
John A. Sellick
Affiliation:
Division of Infectious Diseases, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York Veterans Affairs Western New York Healthcare System, Buffalo, New York
Sheldon Tetewsky
Affiliation:
Veterans Affairs Western New York Healthcare System, Buffalo, New York
Kari A. Mergenhagen*
Affiliation:
Veterans Affairs Western New York Healthcare System, Buffalo, New York
*
Author for correspondence: Kari Mergenhagen, Email: Kari.Mergenhagen@va.gov
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Abstract

Background:

Clostridium difficile infection (CDI) is a reportable hospital metric associated with significant healthcare expenditures. The epidemiology of CDI is pivotal to the implementation of preventative measures.

Objective:

To portray temporal CDI trends in Veterans Health Administration (VA) hospitals.

Design:

A retrospective analysis of veterans who had stool testing for C. difficile.

Setting:

VA acute-care hospitals within the continental United States.

Methods:

Data were mined from the VA’s Corporate Data Warehouse. CDI is reported per 10,000 patient days.

Results:

From 2006 to 2016, 472,346 patients had C. difficile testing. Overall, decreases in incidence of total CDI (16.81 to 13.66) and hospital-onset healthcare facility-associated (HO-HCFA) CDI (10.87 to 6.41) were observed. Temporal increases in the incidence of total and HO-HCFA CDI were associated with the increased use of molecular testing (P < .0001). Decreased use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P = .0002) correlated with decreased rates of CDI, but VA mandatory reporting did not influence CDI rates (P = .24). The overall crude 30-day mortality of patients with CDI decreased from 2.17 deaths per 10,000 patient days in 2006 to 1.41 in 2016. The frequency of International Classification of Disease, Ninth/Tenth Revision (ICD-9/10) discharge diagnosis for CDI was 73.3%.

Conclusion:

Molecular testing was associated with increased incidence of CDI. Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 1 , January 2020 , pp. 44 - 51
Creative Commons
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: This study was presented in part as a poster at #474, IDWeek 2018 on October 4th 2018, in San Francisco, California.

References

Antibiotic resistance threats in the United States. Atlanta: Centers for Disease Control and Prevention; 2013.Google Scholar
Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 2015;175:1792–1801.CrossRefGoogle ScholarPubMed
Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55 suppl 2:S88–S92.CrossRefGoogle Scholar
Evans, CT, Safdar, N. Current Trends in the epidemiology and outcomes of Clostridium difficile infection. Clin Infect Dis 2015;60 suppl 2:S66–S71.CrossRefGoogle Scholar
Kralovic, S, Simbartl, L, LH, D. Clostridium difficile infections in US Department of Veterans Affairs medical centers-nationwide trends for acute care hospitalizations. IDweek 2012;abstract 345.Google Scholar
Evans, ME, Kralovic, SM, Simbartl, LA, Jain, R, Roselle, GA. Effect of a Clostridium difficile infection prevention initiative in Veterans Affairs acute care facilities. Infect Control Hosp Epidemiol 2016;37:720–722.CrossRefGoogle ScholarPubMed
Steiner, C, Barret, M, Weiss, A. HCUP projections: Clostridium difficile hospitalizations 2001 to 2013. HCUP Projections Report no. 2014-01. Agency for Healthcare Research and Quality website. http://www.hcup-us.ahrq.gov/reports/projections/2014-01.pdf, 2014. Accessed September 30, 2019.Google Scholar
Evans, ME, Simbartl, LA, Kralovic, SM, Jain, R, Roselle, GA. Clostridium difficile infections in Veterans Health Administration acute-care facilities. Infect Control Hosp Epidemiol 2014;35:1037–1042.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module protocol. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf, 2017. Accessed September 30, 2019.Google Scholar
Muto, CA, Pokrywka, M, Shutt, K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280.CrossRefGoogle Scholar
Gerding, DN. Clindamycin, cephalosporins, fluoroquinolones, and Clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem. Clin Infect Dis 2004;38:646–648.CrossRefGoogle ScholarPubMed
Balinskaite, V, Johnson, AP, Holmes, A, Aylin, P. The impact of a national antimicrobial stewardship program on antibiotic prescribing in primary care: an interrupted time series analysis. Clin Infect Dis 2019;69:227–232.CrossRefGoogle ScholarPubMed
Brown, KA, Fisman, DN, Moineddin, R, Daneman, N. The magnitude and duration of Clostridium difficile infection risk associated with antibiotic therapy: a hospital cohort study. PLoS One 2014;9:e105454.CrossRefGoogle ScholarPubMed
McFarland, LV, Clarridge, JE, Beneda, HW, Raugi, GJ. Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a Veterans Administration health care system. Clin Infect Dis 2007;45:1141–1151.CrossRefGoogle ScholarPubMed
Alijandai, A. Multivariate Methods and Forecasting with IBM SPSS Statistics. New York: Springer; 2017.CrossRefGoogle Scholar
Reil, M, Hensgens, MP, Kuijper, EJ, et al. Seasonality of Clostridium difficile infections in southern Germany. Epidemiol Infect 2012;140:1787–1793.CrossRefGoogle ScholarPubMed
Reveles, KR, Lawson, KA, Mortensen, EM, et al. National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014. PLoS One 2017;12:e0189227.CrossRefGoogle ScholarPubMed
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;31:382–387.CrossRefGoogle ScholarPubMed
Kelly, AA, Jones, MM, Echevarria, KL, et al. A report of the efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative. Infect Control Hosp Epidemiol 2017;38:513–520.CrossRefGoogle ScholarPubMed
Singh, MB, Evans, ME, Simbartl, LA, Kralovic, SM, Roselle, GA. Evaluating the effect of a Clostridium difficile infection prevention initiative in Veterans Health Administration long-term care facilities. Infect Control Hosp Epidemiol 2018;39:343–345.CrossRefGoogle ScholarPubMed
Reacher, M, Verlander, NQ, Roddick, I, et al. Excess mortality attributable to Clostridium difficile and risk factors for infection in an historic cohort of hospitalised patients followed up in the United Kingdom death register. PLoS One 2016;11:e0149983.CrossRefGoogle Scholar
Karas, JA, Enoch, DA, Aliyu, SH. A review of mortality due to Clostridium difficile infection. J Infect 2010;61:1–8.CrossRefGoogle ScholarPubMed
Frenz, MB, McIntyre, AS. Reducing delays in the diagnosis and treatment of Clostridium difficile diarrhoea. QJM 2003;96:579–582.CrossRefGoogle ScholarPubMed
Barbut, F, Surgers, L, Eckert, C, et al. Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management? Clin Microbiol Infect 2014;20:136–144.CrossRefGoogle ScholarPubMed
Reveles, KR, Pugh, MJV, Lawson, KA, et al. Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003–2014. Am J Infect Control 2018;46:431–435.CrossRefGoogle ScholarPubMed
Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.CrossRefGoogle ScholarPubMed
Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:1010–1013.CrossRefGoogle ScholarPubMed
Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of Clostridium difficile infection rates from 2000 to 2006. Infect Control Hosp Epidemiol 2010;31:1030–1037.CrossRefGoogle ScholarPubMed
Buchner, AM, Sonnenberg, A. Epidemiology of Clostridium difficile infection in a large population of hospitalized US military veterans. Dig Dis Sci 2002;47:201–207.CrossRefGoogle Scholar
Young-Xu, Y, Kuntz, JL, Gerding, DN, et al. Clostridium difficile infection among Veterans Health Administration patients. Infect Control Hosp Epidemiol 2015;36:1038–1045.CrossRefGoogle ScholarPubMed