November 25, 2019 Journal article Open Access

Brown, Kevin A.; McGeer, Allison; Schwartz, Kevin L.; Diong, Christina; Etches, Jacob; Garber, Gary; Johnstone, Jennie; Langford, Bradley; Daneman, Nick

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{
  "DOI": "10.1017/ice.2019.283", 
  "author": [
    {
      "family": "Brown, Kevin A."
    }, 
    {
      "family": "McGeer, Allison"
    }, 
    {
      "family": "Schwartz, Kevin L."
    }, 
    {
      "family": "Diong, Christina"
    }, 
    {
      "family": "Etches, Jacob"
    }, 
    {
      "family": "Garber, Gary"
    }, 
    {
      "family": "Johnstone, Jennie"
    }, 
    {
      "family": "Langford, Bradley"
    }, 
    {
      "family": "Daneman, Nick"
    }
  ], 
  "issued": {
    "date-parts": [
      [
        2019, 
        11, 
        25
      ]
    ]
  }, 
  "abstract": "Objective: Interfacility patient movement plays an important role in the dissemination of antimicrobial-resistant organisms throughout healthcare systems. We evaluated how 3 alternative measures of interfacility patient sharing were associated with C. difficile infection incidence in Ontario acute-care facilities.   \n\nDesign: The cohort included adult acute-care facility stays of \u22653 days between April 2003 and March 2016. We measured 3 facility-level metrics of patient sharing: general patient importation, incidence-weighted patient importation, and C. difficile case importation. Each of the 3 patient-sharing metrics were examined against the incidence of C. difficile infection in the facility per 1,000 stays, using Poisson regression models.   \n\nResults: The analyzed cohort included 6.70 million stays at risk of C. difficile infection across 120 facilities. Over the 13-year period, we included 62,189 new cases of healthcare-associated CDI (incidence, 9.3 per 1,000 stays). After adjustment for facility characteristics, general importation was not strongly associated with C. difficile infection incidence (risk ratio [RR] per doubling, 1.10; 95% confidence interval [CI], 0.97\u20131.24; proportional change in variance [PCV], \u22122.0%). Incidence-weighted (RR per doubling, 1.18; 95% CI, 1.06\u20131.30; PCV, \u22128.4%) and C. difficile case importation (RR per doubling, 1.43; 95% CI, 1.29\u20131.58; PCV, \u221230.1%) were strongly associated with C. difficile infection incidence.   \n\nConclusions: In this 13-year study of acute-care facilities in Ontario, interfacility variation in C. difficile infection incidence was associated with importation of patients from other high-incidence acute-care facilities or specifically of patients with a recent history of C. difficile infection. Regional infection control strategies should consider the potential impact of importation of patients at high risk of C. difficile shedding from outside facilities.", 
  "title": "Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study", 
  "type": "article-journal", 
  "id": "3666980"
}