Interhospital patient transfers between Ontario's academic and large community hospitals increase the risk of Clostridium difficile infection

Publication date: Available online 25 September 2017
Source:American Journal of Infection Control
Author(s): Giulio DiDiodato, Leslie McArthur
BackgroundThe objective of this study is to determine the impact of interhospital patient transfers on the risk of Clostridium difficile infection (CDI).MethodsThe number of interhospital patient transfers and CDI cases for 11 academic and 40 large community hospitals (LCHs) were available from 2010-2015. These data were used to compute a CDI score for each sending facility as a measure of CDI pressure on the receiving facility. This CDI score was included as a variable in a multilevel mixed-effect Poisson regression model of CDI cases. Other covariates included year, CDI testing strategy, antimicrobial stewardship program (ASP), and criteria used for patient isolation. Hospital-specific random effects were estimated for the baseline rate of CDI (intercept) and ASP effect (slope).ResultsThe CDI score ranged from 0-103, with a mean score ± SD of 20.4 ± 21.8. Every 10-point increase in the CDI score was associated with a 4.5% increase in the incidence of CDI in the receiving academic hospital (95% confidence interval [CI], 0.9-8.5) and 3.6% increase in the receiving LCHs (95% CI, 0.3-7). The random components of the model varied significantly, with a strong negative correlation of −0.85 (95% CI, −0.94 to −0.65).ConclusionsOur results suggest interhospital patient transfers increase the risk of CDI. ASPs appear to reduce this risk; however, these ASP effects demonstrate significant heterogeneity across hospitals.



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