Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-26T20:48:03.374Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium difficile-Associated Disease in Patients in a Small Rural Hospital

Published online by Cambridge University Press:  02 January 2015

Jennifer L. Kuntz ,
Joseph E. Cavanaugh ,
Laura K. Becker ,
Melissa A. Ward ,
Dianna M. Appelgate ,
Loreen A. Herwaldt  and
Philip M. Polgreen
Jennifer L. Kuntz
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Joseph E. Cavanaugh
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
Laura K. Becker
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
Melissa A. Ward
Affiliation:
Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Dianna M. Appelgate
Affiliation:
Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Loreen A. Herwaldt
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Philip M. Polgreen*
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
*
University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242 (philip-polgreen@uiowa.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the risk factors for Clostridium difficile–associated disease (CDAD) in a 25-bed rural hospital and to compare antimicrobial use ratios at the study hospital with those at a large academic medical center.

Design.

Case-control study.

Setting.

A 25-bed rural hospital in Iowa during the period from August 2002 through January 2005.

Patients.

A total of 17 case patients with CDAD and 34 control patients matched for age (ie, within 10 years of the case patient's age), sex, and admission date (ie, within 2 weeks of the case patient's admission date).

Methods.

Retrospective medical record review was performed to obtain data on antimicrobial exposures during the 6 weeks before hospital admission for both case and control patients. Exact conditional logistic regression was used for univariable and multivariable analyses. Antimicrobial use ratios were calculated to compare the rates of antimicrobial use for case and control patients at the study hospital with the rates for patients evaluated in a study of CDAD at a nearly 700-bed teaching hospital.

Results.

Case patients had a larger cumulative number of days of antimicrobial use (P = .004), and they received a larger total number of antimicrobial agents during hospitalization (P = .001). Antimicrobial use ratios were higher for both case and control patients at the smaller hospital, compared with the larger hospital.

Conclusions.

CDAD at a small rural hospital was not associated with exposure to the antimicrobial classes that are typically associated with CDAD, but was instead related to the total number of antimicrobials used to treat patients. The rate of antimicrobial use for case and control patients was about 40% higher at the small rural hospital, compared with the corresponding rates at a large academic medical center.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1236 - 1239
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gerding, DN, Olson, MM, Peterson, LR, et al. Clostridium difficile-associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study. Arch Intern Med 1986;146:95–100.CrossRefGoogle ScholarPubMed
2.Fekety, R, Shah, AB. Diagnosis and treatment of Clostridium difficile colitis. JAMA 1993;269:71–75.CrossRefGoogle ScholarPubMed
3.McFarland, LV, Mulligan, MA, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed
4.Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990;336:97–100.CrossRefGoogle ScholarPubMed
5.Muto, CA, Pokrywka, M, Shitt, K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increases fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280.CrossRefGoogle Scholar
6.Harbarth, S, Samore, MH, Carmeli, Y. Antibiotic prophylaxis and the risk of Clostridium difficile-associated diarrhoea. J Hosp Infect 2001;48:93–97.CrossRefGoogle ScholarPubMed
7.Yip, C, Loeb, M, Salama, A, Moss, L, Olde, J. Quinolone use as a risk factor for nosocomial Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol 2001;22:572–575.CrossRefGoogle ScholarPubMed
8.Polgreen, PM, Diekema, DJ, Appelgate, DM, et al. Risk factors for Clostridium difficile–associated disease (CDAD) at a midwestern teaching hospital. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Hospital Epidemiology of America;Chicago, IL;March 18-24, 2006. Abstract 178.Google Scholar
9.McDonald, LC, Coignard, B, Dubberke, E, et al. Recommendations for surveillance of Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
10.Sohn, S, Climo, M, Diekema, D, et al. Varying rates of Clostridium difficile-associated diarrhea at prevention epicenter hospitals. Infect Control Hosp Epidemiol 2005;26:672–675.CrossRefGoogle ScholarPubMed
11.Polgreen, PM, Chen, YY, Cavanaugh, JE, et al. An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol 2007;28:212–214.CrossRefGoogle ScholarPubMed
12.Stevenson, KB, Barbera, J, Moore, JW, Samore, M, Houck, P. Understanding keys to successful implementation of electronic decision support in rural hospitals: analysis of a pilot study for antimicrobial prescribing Am J Med Qual 2005;20:313–318.CrossRefGoogle ScholarPubMed
13.Stevenson, KB, Samore, M, Barbera, J, et al. Pharmacist involvement in antimicrobial use at rural community hospitals in four Western states. Am J Health Syst Pharm 2004;61:787–792.Google Scholar
14.Dickerson, LM, Mainous, AG III, Caerk, PJ. The pharmacist's role in promoting optimal antimicrobial use. Pharmacotherapy 2000;20:711–723.CrossRefGoogle ScholarPubMed
15.Polgreen, PM, Beekmann, SE, Chen, YY, et al. Epidemiology of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a rural state. Infect Control Hosp Epidemiol 2006;27:252.Google Scholar
16.Stevenson, KB, Searle, K, Stoddard, GJ, Samore, MH. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in rural communities, Western United States. Emerg Infect Dis 2005;11:895–903.CrossRefGoogle ScholarPubMed