Healthcare facility-onset, healthcare facility-associated Clostridioides difficile infection in Veterans with spinal cord injury and disorder. (2nd September 2020)

• Record Type: Journal Article
• Authors: Evans, Charlesnika T.; Fitzpatrick, Margaret; Ramanathan, Swetha; Kralovic, Stephen M.; Burns, Stephen P.; Goldstein, Barry; Smith, Bridget; Gerding, Dale N.; Johnson, Stuart
• Is Part Of: Journal of spinal cord medicine. Volume 43:Number 5(2020:Sep.)
• Page Start: 642
• Page End: 652
• Publication Date: 2020-09-02
• Subjects: Clostridioides difficile -- Spinal cord injury -- Proton pump inhibitor -- Antibiotics; Spinal cord -- Wounds and injuries -- Periodicals; Spinal cord -- Diseases -- Periodicals; 616.8305
• DOI: 10.1080/10790268.2019.1672953
• Languages: English
• ISSNs: 1079-0268

Abstract

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.