Charlesnika T Evans1,2, Margaret Fitzpatrick1,3, Swetha Ramanathan1, Stephen M Kralovic4, Stephen P Burns5,6, Barry Goldstein5, Bridget Smith1,7, Dale N Gerding8, Stuart Johnson3,8. 1. Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois, USA. 2. Department of Preventive Medicine and Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA. 3. Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA. 4. Cincinnati VA Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. 5. VA Puget Sound Health Care System, Seattle, Washington, USA. 6. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA. 7. Department of Pediatrics and Center for Community Health, Northwestern University, Chicago, Illinois, USA. 8. Department of Veterans Affairs, Research Service, Edward Hines Jr VA Hospital, Hines, Illinois, USA.
Abstract
Objective: To describe the burden and risk of healthcare facility-onset, healthcare facility-associated (HO-HCFA) Clostridioides difficile infection (CDI) in Veterans with spinal cord injury and disorder (SCI/D). Design: Retrospective, longitudinal cohort study from October 1, 2001-September 30, 2010. Setting: Ninety-four acute care Veterans Affairs facilities. Participants: Patients with SCI/D. Outcomes: Incidence rate of HO-HCFA CDI. Methods: Rates of CDI were determined, and crude unadjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated. Multivariable Poisson random-effects regression analyses were used to assess factors independently associated with the rate of CDI. Results: 1,409 cases of HO-HCFA CDI were identified. CDI rates in 2002 were 13.9/10,000 person-days and decreased to 5.5/10,000 person-days by 2010. Multivariable regression analyses found that antibiotic (IRR = 18.79, 95% CI 14.09-25.07) and proton-pump inhibitor (PPI) or H2 blocker use (IRR = 7.71, 95% CI 5.47-10.86) were both independently associated with HO-HCFA CDI. Exposure to both medications demonstrated a synergistic risk (IRR = 37.55, 95% CI 28.39-49.67). Older age, Northeast region, and invasive respiratory procedure in the prior 30 days were also independent risk factors, while longer SCI duration and care at a SCI center were protective. Conclusion: Although decreasing, CDI rates in patients with SCI/D remain high. Targeted antimicrobial stewardship and pharmacy interventions that reduce antibiotic and PPI/H2 blocker use could have profound benefits in decreasing HO-HCFA CDI in this high-risk population.
Objective: To describe the burden and risk of healthcare facility-onset, healthcare facility-associated (HO-HCFA) Clostridioides difficileinfection (CDI) in Veterans with spinal cord injury and disorder (SCI/D). Design: Retrospective, longitudinal cohort study from October 1, 2001-September 30, 2010. Setting: Ninety-four acute care Veterans Affairs facilities. Participants: Patients with SCI/D. Outcomes: Incidence rate of HO-HCFA CDI. Methods: Rates of CDI were determined, and crude unadjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated. Multivariable Poisson random-effects regression analyses were used to assess factors independently associated with the rate of CDI. Results: 1,409 cases of HO-HCFA CDI were identified. CDI rates in 2002 were 13.9/10,000 person-days and decreased to 5.5/10,000 person-days by 2010. Multivariable regression analyses found that antibiotic (IRR = 18.79, 95% CI 14.09-25.07) and proton-pump inhibitor (PPI) or H2 blocker use (IRR = 7.71, 95% CI 5.47-10.86) were both independently associated with HO-HCFA CDI. Exposure to both medications demonstrated a synergistic risk (IRR = 37.55, 95% CI 28.39-49.67). Older age, Northeast region, and invasive respiratory procedure in the prior 30 days were also independent risk factors, while longer SCI duration and care at a SCI center were protective. Conclusion: Although decreasing, CDI rates in patients with SCI/D remain high. Targeted antimicrobial stewardship and pharmacy interventions that reduce antibiotic and PPI/H2 blocker use could have profound benefits in decreasing HO-HCFA CDI in this high-risk population.
Authors: Michihiko Goto; Amy M J O'Shea; Daniel J Livorsi; Jennifer S McDanel; Makoto M Jones; Kelly K Richardson; Brice F Beck; Bruce Alexander; Martin E Evans; Gary A Roselle; Stephen M Kralovic; Eli N Perencevich Journal: Clin Infect Dis Date: 2016-06-28 Impact factor: 9.079
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Authors: Martin E Evans; Stephen M Kralovic; Loretta A Simbartl; D Scott Obrosky; Margaret C Hammond; Barry Goldstein; Charlesnika T Evans; Gary A Roselle; Rajiv Jain Journal: Am J Infect Control Date: 2012-11-11 Impact factor: 2.918
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Authors: Salva N Balbale; Stuart Johnson; Stephen P Burns; Stephen M Kralovic; Barry Goldstein; Dale N Gerding; Charlesnika T Evans Journal: Infect Control Hosp Epidemiol Date: 2014-03-24 Impact factor: 3.254