Hospitals With Higher Use of Antimicrobials Have Greater C Difficile Burden

Lower use of antimicrobials for clostridium difficile infection associated with a shorter length of stay in hospitals.

A new study finds that hospitals with less than anticipated use of clostridium difficile infection (CDI) antimicrobial use had on average fewer beds, a shorter length of stay, and a greater proportion of undergraduate or nonteaching medical school affiliation.

The study, published online in Infection Control & Hospital Epidemiology, notes that antimicrobial use is typically associated with added burdens and negative outcomes for patients with hospital-acquired CDIs.

The researchers analyzed hospital-level variation in the use of first-line antibiotics for CDI based on the burden of laboratory-identified CDI. They also collected data on hospital-level LabID CDI events and antimicrobial use for CDI, including oral/rectal vancomycin or fidaxomicin.

Using information from the National Healthcare Safety Network in 2019, the researchers assessed the link 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.

The researchers were subsequently able to produce a predicted value of antimicrobial use based on CDI prevalence and test type using negative binomial regression. They then were able to identify hospitals with a significant disparity between CDI prevalence and antimicrobial use using a ratio of observed-to-predicted antimicrobial use.

They included 963 acute-care hospitals in the analysis, which showed that overall, the rate of CDI prevalence had a positive dose-response relationship with the rate of CDI antimicrobial use.

Hospitals with less than anticipated 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 a significant disparity between CDI prevalence and antimicrobial use (n = 902).

However, hospitals with higher-than-expected antimicrobial use (n = 30) were similar overall to hospitals without a significant disparity.

“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.”

The researchers noted that in generally, patients hospitalized with CDI experience a lower quality of life. The investigators reviewed 100 patients hospitalized with CDI at a US tertiary-care referral center, acute-care setting.

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

The study indicated that PROMIS GH physical health summary scores (T = 37.3; P <.001) and mental health summary scores (T = 43.4; P <.001) were significantly lower compared with the general population.

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

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