Characterization of Continued Antibacterial Therapy After Diagnosis of Hospital-Onset Clostridium difficile Infection: Implications for Antimicrobial Stewardship

摘要: Study Objectives To determine the proportion of hospitalized adults with hospital-onset Clostridium difficile infection (CDI) who continued to receive concomitant non-CDI antibacterial agents, characterize therapy that these patients received before and after diagnosis CDI, compare hospital outcomes between those did not have their previous discontinued CDI diagnosis. Design Retrospective cohort study. Data Source Drug use administrative discharge data from 42 United States academic medical centers. Patients A total 5968 adult inpatients January 1, 2002, June 30, 2006. Measurements Main Results We characterized patient-level agent diagnosis. Overall, 3479 (58.3%) for 2 or more days (interhospital range 6.7–72.2%). Although number different agents in week preceding was positively associated therapy, relationship continuation severity illness statistically significant but nonlinear. Patients were receiving oral vancomycin alone less likely (28/61 [45.9%]) than metronidazole (1154/2333 [49.5%]) or both (2297/3576 [64.2%]). After adjusting confounders, had a 62.7% (95% confidence interval [CI] 48.6–78.0%, p<0.001) longer length stay continue therapy; adjusted odds mortality readmission 1.7 CI 1.4–2.1, 1.2 1.1–1.5, p=0.025) times higher, respectively, therapy. Conclusion A majority diagnosis, although interhospital large. Compared study, mortality, subsequent admissions among remained significantly higher confounders. The adverse reflect underlying primary and/or poorer response suggesting an opportunity antimicrobial stewardship programs make important contributions patient care.