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Prior patient receipt of antibiotics increases C. difficile risk for subsequent bed occupants

Patients who occupied the same hospital bed as a prior inhabitant who received antibiotics were at an increased risk for Clostridium difficile infection even if they did not receive antibiotics themselves, according to recent study results published in JAMA Internal Medicine.

“Clostridium difficile infection (CDI) is the most common cause of diarrhea in the hospital and is responsible for an estimated 27,000 deaths annually in the United States,” Daniel E. Freedberg, MD, MS, from the division of digestive and liver diseases at Columbia University Medical Center, and colleagues wrote. “Many factors may increase host susceptibility to CDI, but the most crucial host-related risk factor is exposure to antibiotics.”

“[However], it is uncertain how antibiotics or other CDI risk factors might act on one patient to increase risk for CDI in a subsequent patient who shares the same hospital environment.”

Freedberg and colleagues performed a retrospective cohort study in four hospitals located in the New York metropolitan area to determine if the receipt of antibiotics by prior bed inhabitants influenced the CDI risk in subsequent patients who occupied the same hospital bed. The study included 100,615 pairs of adult patients, hospitalized between 2010 and 2015. The researchers excluded patients who were recently diagnosed with CDI, acquired the infection within 48 hours of hospitalization, had insufficient follow-up time or were given a bed whose prior occupant was released before 24 hours.

Patients who had a positive stool test in a polymerase chain reaction assessment for the C difficile toxin B gene and who then received treatment for CDI were identified as having incident CDI.

Of the 100,615 patient pairs evaluated, 576 (0.57%) had a subsequent patient develop incident CDI. Data indicated a significant association between the development of CDI in subsequent patients and the receipt of antibiotics in prior patients (log-rank P < .01). Additional analysis revealed that this association was unaffected after the researchers excluded 1,497 pairs of patients in which the prior patient had CDI (aHR, 1.2; 95%CI, 1.01-1.43) and adjusted for documented factors that impact CDI risk, such as the receipt of antibiotics by the subsequent patient (aHR, 1.22; 95% CI, 1.02-1.45). There were no other factors related to the prior patient that increased the risk for incident CDI.

“Our results show that antibiotics can potentially cause harm to patients who do not themselves receive the antibiotics and thus emphasize the value of antibiotic stewardship,” Freedberg and colleagues concluded.

“The increase in [CDI] risk was small but is of potential importance given the frequency of use of antibiotics in the hospital.” – by Alaina Tedesco

Disclosure: Freedman reports funding from the National Center for Advancing Translational, National Institutes of Health and a Research Scholar Award from the American Gastroenterological Association.