Association Between High-Risk Medication Usage and Healthcare Facility-Onset C. difficile Infection. (21st April 2016) - Patterson, Julie A.
Abstract : OBJECTIVE: National hospital performance measures for C. difficile infection (CD) are available; comparing antibacterial use among performance levels can aid in identifying effective antimicrobial stewardship strategies to reduce CDI rates. DESIGN: Hospital-level, cross-sectional analysis. METHODS: Hospital characteristics (ie, demographics, medications, patient mix) were obtained for 77 hospitals for 2013. Hospitals were assigned 1 of 3 levels of a CDI standardized infection ratio (SIR): 'Worse than, ' 'Better than, ' or 'No different than' a national benchmark. Analyses compared medication use (total and broad-spectrum antibacterials) for 3 metrics: days of therapy per 1, 000 patient days; length of therapy; and proportion of patients receiving a medication across SIR levels. A multivariate, ordered-probit regression identified characteristics associated with SIR categories. RESULTS: Regarding total average antimicrobial use per patient, there was a significant difference detected in mean length of therapy: 'No different' hospitals having the longest (4.93 days) versus 'Worse' (4.78 days) and 'Better' (4.43 days) ( P <.01). 'Better' hospitals used fewer total antibacterials (693 days of therapy per 1, 000 patient days) versus 'No different' (776 days) versus 'Worse' (777 days) ( P <.05). The 'Better' hospitals used broad-spectrum antibacterials for a shorter average length of therapy (4.03 days) versus 'No different' (4.51 days) versus 'Worse' (4.38 days) ( P <.05). 'Better' hospitals used fewer broad-spectrum antibacterials (310 days of therapy per 1, 000 patient days) versus 'No different' (364 days) versus 'Worse' (349 days) ( P <.05). Multivariate analysis revealed that the proportion of elderly patients and chemotherapy days of therapy per 1, 000 patient days was significantly negatively associated with the SIR. CONCLUSIONS: These findings have potential implications regarding the need to fully account for hospital patient mix when carrying out inter-hospital comparisons of CDI rates. Infect Control Hosp Epidemiol 2016;37:909–915