Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014

Kelly R. Reveles, Mary Jo V. Pugh, Kenneth A. Lawson, Eric M. Mortensen, Jim M. Koeller, Jacqueline R. Argamany, Christopher R. Frei

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression. Results: Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2%), followed by CO-HCFA-CDI (20.6%) and CA-CDI (19.2%). The proportion of patients with HCFO-CDI decreased from 73.5% during fiscal year 2003 to 53.2% during fiscal year 2014, whereas CA-CDI increased from 8.3% to 26.7%. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95% CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95% CI, 0.37-0.46). Conclusions: HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.

Original languageEnglish (US)
JournalAmerican Journal of Infection Control
DOIs
StateAccepted/In press - Jan 1 2017

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Veterans Health
Clostridium Infections
United States Department of Veterans Affairs
Clostridium difficile
Health Facilities
Delivery of Health Care
Odds Ratio
Confidence Intervals
Centers for Medicare and Medicaid Services (U.S.)
Community Health Services
Informatics
Mortality
Veterans
Carbon Monoxide
Inpatients

Keywords

  • Epidemiology
  • Healthcare-associated infection

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014. / Reveles, Kelly R.; Pugh, Mary Jo V.; Lawson, Kenneth A.; Mortensen, Eric M.; Koeller, Jim M.; Argamany, Jacqueline R.; Frei, Christopher R.

In: American Journal of Infection Control, 01.01.2017.

Research output: Contribution to journalArticle

Reveles, Kelly R. ; Pugh, Mary Jo V. ; Lawson, Kenneth A. ; Mortensen, Eric M. ; Koeller, Jim M. ; Argamany, Jacqueline R. ; Frei, Christopher R. / Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014. In: American Journal of Infection Control. 2017.
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abstract = "Background: Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression. Results: Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2{\%}), followed by CO-HCFA-CDI (20.6{\%}) and CA-CDI (19.2{\%}). The proportion of patients with HCFO-CDI decreased from 73.5{\%} during fiscal year 2003 to 53.2{\%} during fiscal year 2014, whereas CA-CDI increased from 8.3{\%} to 26.7{\%}. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95{\%} confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95{\%} CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95{\%} CI, 0.37-0.46). Conclusions: HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.",
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T1 - Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014

AU - Reveles, Kelly R.

AU - Pugh, Mary Jo V.

AU - Lawson, Kenneth A.

AU - Mortensen, Eric M.

AU - Koeller, Jim M.

AU - Argamany, Jacqueline R.

AU - Frei, Christopher R.

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N2 - Background: Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression. Results: Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2%), followed by CO-HCFA-CDI (20.6%) and CA-CDI (19.2%). The proportion of patients with HCFO-CDI decreased from 73.5% during fiscal year 2003 to 53.2% during fiscal year 2014, whereas CA-CDI increased from 8.3% to 26.7%. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95% CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95% CI, 0.37-0.46). Conclusions: HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.

AB - Background: Clostridium difficile infection (CDI) occurs frequently in inpatient settings; however, community-onset cases have been reported more frequently in recent years. This study evaluated hospital-onset and community-onset CDI in the national Veterans Health Administration (VHA) population over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI between October 1, 2002, and September 30, 2014. Data were obtained from the Veterans Affairs Informatics and Computing Infrastructure. CDI was categorized into community-associated CDI (CA-CDI); community-onset, health care facility-associated CDI; and health care facility-onset CDI (HCFO-CDI). Each type was described longitudinally and was assessed as an independent risk factor for health outcomes using multivariable logistic regression. Results: Overall, 30,326 patients with a first CDI episode were included. HCFO-CDI was the predominant type (60.2%), followed by CO-HCFA-CDI (20.6%) and CA-CDI (19.2%). The proportion of patients with HCFO-CDI decreased from 73.5% during fiscal year 2003 to 53.2% during fiscal year 2014, whereas CA-CDI increased from 8.3% to 26.7%. HCFO-CDI was a positive predictor of severe CDI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.59-1.84) and 30-day mortality (OR, 1.46; 95% CI, 1.32-1.61), but a negative predictor of 60-day recurrence (OR, 0.41; 95% CI, 0.37-0.46). Conclusions: HCFO-CDI was the predominant CDI type. The proportion of patients with CA-CDI increased and HCFO-CDI decreased in recent years. Patients with HCFO-CDI experienced higher rates of severe CDI and mortality.

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