Nina R Joyce1, Eleftherios Mylonakis2, Vincent Mor3,4. 1. Department of Health Care Policy, School of Medicine, Harvard University, Boston, Massachusetts. 2. Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island. 3. Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island. 4. Providence Veterans Administration Medical Center, Providence, Rhode Island.
Abstract
OBJECTIVES: To assess the effect of facility Clostridium difficile infection (CDI) prevalence on risk of healthcare facility (HFC) acquired CDI. DESIGN: Retrospective cohort study. SETTING: Medicare fee-for-service (FFS) claims and skilled nursing facility (SNF) Minimum Data Set 3.0 assessments. PARTICIPANTS: Medicare beneficiaries with 90 days or more of no contact with a HCF before a hospital admission without a CDI diagnosis. Participants were separated into two cohorts: discharged to the community and discharged to a SNF. MEASUREMENTS: Risk of HCF-acquired CDI associated with CDI prevalence at the index facility measured according to 30-day rehospitalization with a discharge diagnosis of CDI or diagnosis in the SNF after admission. Hospital and SNF CDI prevalence were categorized into three groups: 0% and above and below the median value for facilities with greater than 0% prevalence. RESULTS: Of 817,900 eligible individuals, there were 553,423 admissions in the first cohort (discharged to the community) and 315,109 in the second (discharged to a SNF). In the first cohort, the risk of HCF-acquired CDI was higher for individuals admitted to hospitals with CDI prevalence less than the median (relative risk (RR) = 1.58, 95% confidence interval (CI) = 1.18-2.12) and greater than the median (RR = 2.56, 95% CI = 1.91-3.45) than for those with no CDI. In the second cohort, the risk of HCF-acquired CDI was greater for individuals admitted to a hospital (RR = 1.89, 95% CI = 1.49-2.39) and a SNF (RR = 1.48, 95% CI = 1.31-1.67) with CDI prevalence greater than the median. CONCLUSION: The risk of HCF-acquired CDI is greater for noninfected individuals admitted to hospitals and SNFs with a high prevalence of CDI.
OBJECTIVES: To assess the effect of facility Clostridium difficile infection (CDI) prevalence on risk of healthcare facility (HFC) acquired CDI. DESIGN: Retrospective cohort study. SETTING: Medicare fee-for-service (FFS) claims and skilled nursing facility (SNF) Minimum Data Set 3.0 assessments. PARTICIPANTS: Medicare beneficiaries with 90 days or more of no contact with a HCF before a hospital admission without a CDI diagnosis. Participants were separated into two cohorts: discharged to the community and discharged to a SNF. MEASUREMENTS: Risk of HCF-acquired CDI associated with CDI prevalence at the index facility measured according to 30-day rehospitalization with a discharge diagnosis of CDI or diagnosis in the SNF after admission. Hospital and SNF CDI prevalence were categorized into three groups: 0% and above and below the median value for facilities with greater than 0% prevalence. RESULTS: Of 817,900 eligible individuals, there were 553,423 admissions in the first cohort (discharged to the community) and 315,109 in the second (discharged to a SNF). In the first cohort, the risk of HCF-acquired CDI was higher for individuals admitted to hospitals with CDI prevalence less than the median (relative risk (RR) = 1.58, 95% confidence interval (CI) = 1.18-2.12) and greater than the median (RR = 2.56, 95% CI = 1.91-3.45) than for those with no CDI. In the second cohort, the risk of HCF-acquired CDI was greater for individuals admitted to a hospital (RR = 1.89, 95% CI = 1.49-2.39) and a SNF (RR = 1.48, 95% CI = 1.31-1.67) with CDI prevalence greater than the median. CONCLUSION: The risk of HCF-acquired CDI is greater for noninfected individuals admitted to hospitals and SNFs with a high prevalence of CDI.
Authors: Nick Daneman; Susan E Bronskill; Andrea Gruneir; Alice M Newman; Hadas D Fischer; Paula A Rochon; Geoffrey M Anderson; Chaim M Bell Journal: JAMA Intern Med Date: 2015-08 Impact factor: 21.873
Authors: Fernanda C Lessa; Yi Mu; Wendy M Bamberg; Zintars G Beldavs; Ghinwa K Dumyati; John R Dunn; Monica M Farley; Stacy M Holzbauer; James I Meek; Erin C Phipps; Lucy E Wilson; Lisa G Winston; Jessica A Cohen; Brandi M Limbago; Scott K Fridkin; Dale N Gerding; L Clifford McDonald Journal: N Engl J Med Date: 2015-02-26 Impact factor: 91.245
Authors: Miao He; Fabio Miyajima; Paul Roberts; Louise Ellison; Derek J Pickard; Melissa J Martin; Thomas R Connor; Simon R Harris; Derek Fairley; Kathleen B Bamford; Stephanie D'Arc; Jon Brazier; Derek Brown; John E Coia; Gill Douce; Dale Gerding; Hee Jung Kim; Tse Hsien Koh; Haru Kato; Mitsutoshi Senoh; Tom Louie; Stephen Michell; Emma Butt; Sharon J Peacock; Nick M Brown; Tom Riley; Glen Songer; Mark Wilcox; Munir Pirmohamed; Ed Kuijper; Peter Hawkey; Brendan W Wren; Gordon Dougan; Julian Parkhill; Trevor D Lawley Journal: Nat Genet Date: 2012-12-09 Impact factor: 38.330