Thirty-three percent of patients admitted with community-onset Clostridioides difficile infection (CDI) were discharged from the same hospital within the previous three months, according to the CDC.
The findings point to the need for better hospital antibiotic stewardship and possibly additional interventions to ensure patients do not leave the hospital colonized with C. difficile.
“Interventions to reduce community-onset CDI are not typically hospital-based. There is a common perception that community-onset CDI is often acquired outside the hospital,” said Alice Guh, MD, MPH, a researcher in the CDC’s Division of Healthcare Quality Promotion, in Atlanta.
Dr. Guh, who presented the findings at IDWeek 2020 (poster 780), said her group’s results suggest that “hospital-based and post-discharge interventions aimed at improving antibiotic use could potentially help reduce subsequent CDI hospitalizations.”
The researchers reached their conclusion after examining medical records from 4,724 patients hospitalized with CDI—including 2,984 with community-onset CDI—at 86 hospitals in 10 states. Patients with C. difficile found in stool specimens collected after the third day following admission were considered to have hospital-onset CDI, while those with C. difficile found in stool collected within three days of admission were considered to have community-onset CDI.
The investigators further classified community-onset CDI cases into four categories: cases with onset in a long-term care facility (LTCF), cases with onset in a long-term acute care hospital, cases that were health care facility–associated (HCFA)—medical record documented an overnight stay at a health care facility in the prior 12 weeks, but patient was admitted from a private residence—and cases with no documented overnight stays in a health care facility in the 12 weeks before hospital admission.
According to Dr. Guh and her team, 1,201 cases were HCFA. An overlapping 13% of these patients also had a prior LTCF stay during this period.
Moreover, they found that 83% (978/1,174) of the patients who had been hospitalized during the 12 weeks before hospitalization for community-onset CDI had been discharged from the same hospital where they received inpatient CDI care, 33% (978/2,984) of all patients in the study with community-onset CDI.
Dr. Guh’s team also found that 84% of these individuals had received an antibiotic during the 12 prior weeks. They were not able to pinpoint where the antibiotics were administered or prescribed, but they said these patients “likely received antibiotics during or soon after the previous admission.”
The authors noted that medical records may be incomplete, leaving open the possibility that rates of prior hospitalizations and antibiotic exposure in this population were higher than documented.
Originally published by our sister publication, Infectious Disease Special Edition
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