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Vaccine. 2015 Nov 17;33(46):6241-9. doi: 10.1016/j.vaccine.2015.09.078. Epub 2015 Oct 9.

Identification of population at risk for future Clostridium difficile infection following hospital discharge to be targeted for vaccine trials.

Author information

1
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States. Electronic address: jbaggs@cdc.gov.
2
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, United States.
3
University of Rochester Medical Center, Rochester, NY, United States.
4
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States; Atlanta Research and Education Foundation, Atlanta, GA, United States.
5
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.

Abstract

BACKGROUND:

Efforts to develop a Clostridium difficile vaccine are underway; identification of patients at risk for C. difficile infection (CDI) is critical to inform vaccine trials. We identified groups at high risk of CDI ≥ 2 8 days after hospital discharge.

METHODS:

Hospital discharge data and pharmacy data from two large academic centers, in New York and Connecticut, were linked to active population-based CDI surveillance data from the Emerging Infections Program (EIP). Adult residents of the EIP surveillance area were included if they had an inpatient stay at a study hospital without prior history of CDI. The primary outcome was CDI by either toxin or molecular assay ≥ 28 days after an index hospitalization. Important predictors of CDI ≥ 28 days post discharge were initially identified through a Cox proportional hazards model (stepwise backward selection) using a derivation cohort; final model parameters were used to develop a risk score evaluated in the validation cohort.

RESULTS:

Of the 35,186 index hospitalizations, 288 (0.82%) had CDI ≥ 28 days post discharge. After parameter selection, age, number of hospitalizations in the prior 90 days, admission diagnosis, and the use of 3rd/4th generation cephalosporin, clindamycin or fluoroquinolone antibiotic classes remained in the model. Using the validation cohort, the risk score was predictive (p<0.001) with a c-score of 0.75. Based on the distribution of scores in the derivation cohort, we divided the patients into low and high risk groups. In the high risk group, 1.6% experienced CDI ≥ 28 days post discharge compared to 0.3% among our low risk group.

CONCLUSIONS:

Our study identified specific parameters for a risk score that can be applied at discharge to identify a patient population whose risk of CDI ≥ 28 days following an acute care hospitalization was 5 times greater than other patients.

KEYWORDS:

Administrative data; Anti-bacterial agents; Clostridium difficile infection; Health care-associated infections; Vaccines

PMID:
26450660
PMCID:
PMC4702247
DOI:
10.1016/j.vaccine.2015.09.078
[Indexed for MEDLINE]
Free PMC Article
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