Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection: A Population Based U.S.-wide Study

Ioannis M. Zacharioudakis; Fainareti N. Zervou; Fadi Shehadeh; Evangelia K. Mylona; Eleftherios Mylonakis

doi:10.1016/j.eclinm.2019.02.001

Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection: A Population Based U.S.-wide Study

Ioannis M. Zacharioudakis, Fainareti N. Zervou, Fadi Shehadeh, Evangelia K. Mylona, Eleftherios Mylonakis

Houston Methodist

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	12-19
Number of pages	8
Journal	EClinicalMedicine
Volume	8
DOIs	https://doi.org/10.1016/j.eclinm.2019.02.001
State	Published - Feb 2019

Keywords

Clostridioides difficile
Clostridium difficile
Geographically weighted regression model
HO-CDI
Risk factors
Spatial statistical analysis

ASJC Scopus subject areas

General Medicine

Divisions

Infectious Disease

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10.1016/j.eclinm.2019.02.001

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@article{c9511790a1494460a7eca5712c7b5ec4,

title = "Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection: A Population Based U.S.-wide Study",

abstract = "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.",

keywords = "Clostridioides difficile, Clostridium difficile, Geographically weighted regression model, HO-CDI, Risk factors, Spatial statistical analysis",

author = "Zacharioudakis, \{Ioannis M.\} and Zervou, \{Fainareti N.\} and Fadi Shehadeh and Mylona, \{Evangelia K.\} and Eleftherios Mylonakis",

note = "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: {\textcopyright} 2019",

year = "2019",

month = feb,

doi = "10.1016/j.eclinm.2019.02.001",

language = "English (US)",

volume = "8",

pages = "12--19",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd",

}

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 -

Association of Community Factors with Hospital-onset Clostridioides (Clostridium) difficile Infection: A Population Based U.S.-wide Study

Abstract

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