Primary Diagnoses Associated with Increased Risk of Hospital Onset Clostridium difficile Infection 公开
Edison, Laura (2012)
Published
Abstract
Background: Clostridium difficile has emerged as a
significant cause of healthcare-
associated infections and the most common cause of healthcare
associated diarrhea;
increasing in incidence and severity over the last decade. The
changing epidemiology
and high cost of the disease has led to efforts to better
understand the organism and
how to stratify patients according to their risk of developing
Clostridium difficile
infection (CDI) in order to
effectively direct infection control efforts and fairly
report
hospital infection rates. Little is known about risk stratification
using administrative
data sources, and primary diagnosis as a risk factor for infection
has rarely been
examined. This thesis examines hospital inpatient primary diagnoses
as risk factors for
Hospital Onset CDI (HO-CDI) using administrative data.
Methods: We conducted a retrospective cohort study
using hospital discharge data
from the 2009 Nationwide Inpatient Sample, Healthcare Cost and
Utilization Project.
HO-CDI was the dependent variable and defined as a non-primary
diagnosis of CDI with
a length of stay (LOS) greater than two days. The primary
independent variable was the
clinical category (CCS) of the primary diagnosis. LOS, number of
chronic conditions, age
category and transfer in from a healthcare facility were examined
as possible
confounders or effect modifiers.
Results: Of the 285 CCS examined using multivariate
analysis, 23 yielded a significant
risk difference greater than 10/1,000 discharges. All independent
variables had a
significant effect on the relationship of CCS to HO-CDI. The CCS
that had the strongest
association with HO-CDI are septicemia, HIV, cystic fibrosis and
mycoses.
Conclusions: All of the CCS signifcantly associated
with HO-CDI are surrogates for
known risk factors, antimicrobial use and healthcare exposure.
Administrative data can
be used to determine which CCS are significantly associated with
HO-CDI and can be
used to assess a patient's risk for HO-CDI. This risk
stratification will improve the ability
of hospital and public health decison makers to allocate resources
in preventing HO-CDI,
and can help refine a national CDI reporting system to achieve
risk-adjusted
benchmarking of facility infection rates.
Table of Contents
Table of Contents
Introduction. 1
C. difficile Overview. 2
Virulence and Pathogenesis . 2
Clinical Disease. 3
Diagnosis. 4
Treatment. 5
Prevention and Control . 6
C. difficile Epidemiology and Attributable Cost. 7
Risk Factors . 8
C. difficile Surveillance and Mandatory Reporting. 12
Methods. 15
Results. 20
Discussion. 27
Strengths & Limitations. 32
Conclusions and Recommendations. 35
References. 38
Appendix A: Additional Methods. 41
Appendix B: Tables. 43
Appendix C: Emory IRB Exemption Letter. 56
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| 关键词 | |
| Committee Chair / Thesis Advisor | |
| Committee Members | |
| Partnering Agencies |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Primary Diagnoses Associated with Increased Risk of Hospital Onset Clostridium difficile Infection () | 2018-08-28 16:30:46 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|