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EHRs effectively identified risk for C. difficile in patients

Zilberberg MD. Infect Control Hosp Epidemiol. 2011;[published online ahead of print June 1, 2011].

Issue: July 2011

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Electronic health records, or EHRs, may help to determine patients’ risk for Clostridium difficile infection by age and community-onset, nonhospital-associated prevalence upon admission, according to new findings published in Infection Control and Hospital Epidemiology.

“As the practice of interhospital comparisons becomes more common, it will be important to improve methods for risk stratification of CDI rates,” the researchers wrote. “Within this context, electronic surveillance, if feasible and accurate, may be an attractive way to track care delivery and its outcomes within our hospitals.”

L. Clifford McDonald, MD, FACP, chief of the Prevention and Response Branch of the CDC, and colleagues assessed risk-stratification methods for public reporting of health care-associated infections among patients aged 18 years or older with nonrecurrent CDI across 85 hospitals between January 2007 and June 2008.

Of the 9,803 CDI cases identified, 50.6% were hospital-onset (HO); 23% were community-onset, nonhospital-associated (CO-NHA); 17.4% were community-onset, hospital-associated (CO-HA); and 9% were community-onset, indeterminate hospital association (CO-IN).

The incidence density of HO was 6.3/10,000 patient-days; the prevalence of CO-CDI on admission (per 10,000 admissions) was 8.4 for CO-HA; 4.4 for CO-IN; and 11.1 for CO-NHA. Higher rates of HO-CDI (P<.0001) were associated with older age, higher CO-NHA prevalence on admission, and increased C. difficile testing intensity, the researchers wrote.

“We found that CO-NHA-CDI prevalence on admission and age-adjusted patient-days each contribute to improved risk stratification for HO-CDI,” the researchers wrote. “Although age is a well-recognized factor for CDI and explains some differences in rates across different hospital demographic types, CO-NHA prevalence on admission remains independently associated with HO-CDI across all facilities. In addition, we demonstrated that a facility-level variable measuring C. difficile testing intensity is positively associated with higher rates of HO-CDI.”

Disclosure: The researchers report no relevant financial disclosures.

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