Patients With Comorbid Conditions Have Greater Risk of Hospital-Onset C. difficile Infection

A recent AHRQ-funded study found that adult hospital patients were at greater risk for acquiring Clostridium difficile infection if they were older, had received certain medications or had comorbid conditions including weight loss, certain blood disorders, renal failure or certain neurological disorders. Clostridium difficile, or C. diff, is a healthcare-associated intestinal infection that results in approximately 15,000 deaths per year. Using ICD-10 codes, researchers examined electronic health record data on patients admitted to the University of Maryland Medical Center between November 2015 and May 2017, and captured the presence of comorbid conditions using the AHRQ Elixhauser Comorbidity Index. They concluded that increased Elixhauser scores are associated with increased Clostridium difficileinfection risk, and that the use of methods such as the Elixhauser Comorbidity Index should be considered for risk-adjustment of Clostridium difficile infection rates. Access the abstract of the study, published in Infection Control and Hospital Epidemiology.

2018 Mar;39(3):297-301. doi: 10.1017/ice.2018.10. Epub 2018 Feb 5.

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection.

Harris AD1, Sbarra AN2, Leekha S1, Jackson SS1, Johnson JK1, Pineles L1, Thom KA1.

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Abstract

OBJECTIVE To analyze whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use. PATIENTS Patients aged ≥18 years admitted to the University of Maryland Medical Center between November 7, 2015, and May 31, 2017. METHODS Comorbid conditions were assessed using the Elixhauser comorbidity index. The Elixhauser comorbidity index and the comorbid condition components were calculated using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes extracted from electronic medical records. Bivariate associations between CDI and potential covariates for multivariable regression, including antibiotic use, gastric acid suppression therapy use, as well as comorbid conditions, were estimated using log binomial multivariable regression. RESULTS After controlling for antibiotic use, age, proton-pump inhibitor use, and histamine-blocker use, the Elixhauser comorbidity index was a significant risk factor for predicting CDI. There was an increased risk of 1.26 (95% CI, 1.19-1.32) of having CDI for each additional Elixhauser point added to the total Elixhauser score. CONCLUSIONS An increase in Elixhauser score is associated with CDI. Our study and other studies have shown that comorbid conditions are important risk factors for CDI. Electronically available comorbid conditions and scores like the Elixhauser index should be considered for risk-adjustment of CDC CDI rates. Infect Control Hosp Epidemiol 2018;39:297-301.