TY - JOUR
T1 - Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection
T2 - A Population Based U.S.-wide Study
AU - Zacharioudakis, Ioannis M.
AU - Zervou, Fainareti N.
AU - Shehadeh, Fadi
AU - Mylona, Evangelia K.
AU - Mylonakis, Eleftherios
N1 - Funding Information:
EM has received grant support from Boehringer Ingelheim, Germany; T2 Biosystems, United States and Sanofi Pasteur, United States. The other authors have no conflict of interest to declare.
Funding Information:
EM has received grant support from Boehringer Ingelheim , Germany; T2 Biosystems , United States and Sanofi Pasteur , United States. The other authors have no conflict of interest to declare.
Publisher Copyright:
© 2019
PY - 2019/2
Y1 - 2019/2
N2 - Background: Clostridioides (Clostridium) difficile ranks first among the pathogens of hospital-acquired infections with hospital-based preventive strategies being only partially successful in containing its spread. Methods: We performed a spatial statistical analysis to examine the association between population characteristics and parameters of community healthcare practice and delivery with hospital-onset Clostridioides (Clostridium) difficile 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. Findings: 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 km2 was associated with 10% (R2 = 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 (R2 = 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. Interpretation: 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.
AB - Background: Clostridioides (Clostridium) difficile ranks first among the pathogens of hospital-acquired infections with hospital-based preventive strategies being only partially successful in containing its spread. Methods: We performed a spatial statistical analysis to examine the association between population characteristics and parameters of community healthcare practice and delivery with hospital-onset Clostridioides (Clostridium) difficile 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. Findings: 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 km2 was associated with 10% (R2 = 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 (R2 = 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. Interpretation: 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.
KW - Clostridioides difficile
KW - Clostridium difficile
KW - Geographically weighted regression model
KW - HO-CDI
KW - Risk factors
KW - Spatial statistical analysis
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U2 - 10.1016/j.eclinm.2019.02.001
DO - 10.1016/j.eclinm.2019.02.001
M3 - Article
AN - SCOPUS:85064159223
SN - 2589-5370
VL - 8
SP - 12
EP - 19
JO - EClinicalMedicine
JF - EClinicalMedicine
ER -