A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

• DOI: 10.1017/ice.2015.220
• Publication Date: 2015-09-21T05:28:54Z
• Authors: Sara Y. Tartof; Gunter K. Rieg; Rong Wei; Hung Fu Tseng; Steven J. Jacobsen; Kalvin C. Yu
• Keywords: Antimicrobial Stewardship; Cefuroxime

Limitations in sample size, overly inclusive antibiotic classes, lack of adjustment key risk variables, and inadequate assessment cases contribute to widely ranging estimates factors for Clostridium difficile infection (CDI).To incorporate all CDI addition 27 classes into a single comprehensive model.Retrospective cohort study.Kaiser Permanente Southern California.Members Kaiser California at least 18 years old admitted any its 14 hospitals from January 1, 2011, through December 31, 2012.Hospital-acquired were identified by polymerase chain reaction assay. Exposure major outpatient antibiotics (10 classes) those administered during inpatient stays (27 was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer skilled nursing facility, number different statin use, proton pump inhibitor use also Poisson regression estimated adjusted CDI.A total 401,234 patients with 2,638 incident (0.7%) detected. The final model demonstrated highest associated increasing age, exposure multiple facility transfer. Factors conferring the most reduced tetracyclines first-generation cephalosporins, macrolides. CONCLUSIONS Although type aggregate are important, that increase likelihood environmental spore acquisition should not be underestimated. Operationally, our findings have implications stewardship efforts can inform empirical culture-driven treatment approaches.