Association of Community Factors with Hospital-onset <i>Clostridioides</i> (<i>Clostridium</i>) <i>difficile</i> Infection: A Population Based U.S.-wide Study.
cross_sectional · Level IV
Where this comes from
- Record sourced from PubMed, PMID 31193719.
- Also identified by DOI 10.1016/j.eclinm.2019.02.001 and PMC identifier 6537581.
- Licence recorded as CC BY-NC-ND.
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Abstract
<i>Clostridioides</i> (<i>Clostridium</i>) <i>difficile</i> ranks first among the pathogens of hospital-acquired infections with hospital-based preventive strategies being only partially successful in containing its spread. We performed a spatial statistical analysis to examine the association between population characteristics and parameters of community healthcare practice and delivery with hospital-onset <i>Clostridioides</i> (<i>Clostridium</i>) <i>difficile</i> infection (HO-CDI), using data from the Medicare Hospital Compare, Medicare Provider Utilization Part D, and other databases. Among the areas with the highest HO-CDI rates ("hot spots"), we conducted a geographically weighted regression (GWR) to quantify the effect of the decrease in the modifiable risk factors on the HO-CDI rate. Percentage of population > 85 years old, community claims of antimicrobial agents and acid suppressants, and density of hospitals and nursing homes within the hospital service areas (HSAs) had a statistically significant association with the HO-CDI incidence (p < 0.001). The model including the community claims of antimicrobial agents and number of hospital centers per HSA km<sup>2</sup> was associated with 10% (R<sup>2</sup> = 0.10, p < 0.001) of the observed variation in HO-CDI rate. The hot spots were organized into 5 Combined Statistical areas that crossed state borders. The association of the antimicrobial claims and HO-CDI rate was as high as 71% in the Boston-Worcester-Providence area (R<sup>2</sup> = 0.71, SD 0.19), with a 10% decrease in the rate of antimicrobial claims having the potential to lead to up to 23.1% decrease in the HO-CDI incidence in this area. These results outline the association of HO-CDI with community practice and characteristics of the healthcare delivery system and support the need to further study the effect of community and nursing home-based antimicrobial and acid suppressant stewardship programs in the rate of HO-CDI in geographic areas that may cross state lines.