Temporal change of risk factors in hospital-acquired Clostridioides difficile infection using time-trend analysis.

摘要: OBJECTIVE Given recent changes in the epidemiology of Clostridioides difficile infection (CDI) and prevention efforts, we investigated temporal over a period 11 years (2006-2016) incidence risk factors for CDI. DESIGN Retrospective matched case-control study. SETTING/PATIENTS Pediatric adult inpatients (n = 694,849) discharged from 3 hospitals (tertiary quaternary care, community, pediatric) large, academic health center New York City. METHODS Risk were identified cases controls by length stay at ratio 1:4. A Cochran-Armitage or Mann-Kendall test was used to investigate trends factors. RESULTS Of 694,849 inpatients, 6,038 (0.87%) had CDI: 44% these hospital acquired (HA-CDI) 56% community (CA-CDI). We observed downward HA-CDI (-0.03% per year) upward CA-CDI (+0.04% year). Over time, antibiotics administered more patients (+3% year); use high-risk declined (-1.2% antibiotic duration increased with (+4.4% Fewer proton-pump inhibitors histamine-2 blockers (-3.8% +7.3% year, respectively; all Ptrend <.05). CONCLUSIONS Although decreased simultaneously increased. Continued efforts assure judicious inpatient settings is clearly vital. Measuring actual level exposure an (incidence density) should be ongoing surveillance assessment.