Hospitals With Higher Antimicrobial Use Have Larger C Difficile Issues

Antimicrobial use has long been associated with additional burdens and negative outcomes for patients with hospital-acquired clostridium difficile infections (CDI).

A team, led by Kerui Xu, PhD, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, evaluated hospital-level variation in using first-line antibiotics for CDI based on the burden of laboratory-identified CDI.

In the study, the investigators gathered data on hospital-level LabID CDI events and antimicrobial use for CDI, including oral/rectal vancomycin or fidaxomicin.

The National Healthcare Safety Network

They used information from the National Healthcare Safety Network in 2019 and assessed the association between hospital-level CDI prevalence per 100 patient admissions and the rate of CDI antimicrobial use for the days of therapy per 1000 days present.

This enabled the investigators to generate a predicted value of antimicrobial use based on C difficile infection prevalence and test type using negative binomial regression.

They then identified hospitals with extreme discordance between CDI prevalence and antimicrobial use using the ratio of the observed to predicted antimicrobial use.

There was a total of 963 acute-care hospitals included in the analysis. Overall, the rate of CDI prevalence showed a positive dose-response relationship with the rate of CDI antimicrobial use.

Comparing the Results

The investigators found hospitals with lower-than-expected CDI antimicrobial use (n = 31) had on average fewer beds (median, 106 vs 208), shorter length of stay (median, 3.8 vs 4.2 days), and higher proportion of undergraduate or nonteaching medical school affiliation (48% vs 39%) than hospitals without extreme discordance (n = 902).

However, hospitals with higher-than-expected antimicrobial use (n = 30) were similar overall to the hospitals without extreme discordance.

“The prevalence rate of LabID CDI had a significant dose–response association with first-line antibiotics for treating CDI,” the authors wrote. “We identified hospitals with extreme discordance between CDI prevalence and CDI [antimicrobial use], highlighting potential opportunities for data validation and improvements in diagnostic and treatment practices for CDI.”

Quality of Life

Generally speaking patients who are hospitalized with Clostridioides difficile infections (CDI) suffer from a lower quality of life.

In a prospective survey study, the investigators reviewed 100 adults hospitalized with CDI at a US tertiary-care referral center, acute-care setting.

Patients were surveyed between July 2019 and March 2020. The survey was conducted using the disease-specific Cdiff32 questionnaire and the generic PROMIS GH survey.

The results show PROMIS GH physical health summary scores (T = 37.3; P <.001) and mental health summary scores (T = 43.4; P <.001) were significantly lower in comparison to the general population.

For the subgroups, recurrent CDI, severe CDI, and the number of stools were linked to lower Cdiff32 scores after using bivariate analysis.

In addition, multivariable linear regression showed recurrent CDI, severe CDI, and each additional stool in the preceding 24 hours were associated with significantly decreased Cdiff32 scores.

The study, “Association between prevalence of laboratory-identified Clostridioides difficile infection (CDI) and antibiotic treatment for CDI in US acute-care hospitals, 2019,” was published online in Infection Control & Hospital Epidemiology.