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Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study

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


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  <identifier identifierType="URL">https://zenodo.org/record/3666980</identifier>
  <creators>
    <creator>
      <creatorName>Brown, Kevin A.</creatorName>
      <givenName>Kevin A.</givenName>
      <familyName>Brown</familyName>
      <nameIdentifier nameIdentifierScheme="ORCID" schemeURI="http://orcid.org/">0000-0002-1483-2188</nameIdentifier>
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    <creator>
      <creatorName>McGeer, Allison</creatorName>
      <givenName>Allison</givenName>
      <familyName>McGeer</familyName>
    </creator>
    <creator>
      <creatorName>Schwartz, Kevin L.</creatorName>
      <givenName>Kevin L.</givenName>
      <familyName>Schwartz</familyName>
    </creator>
    <creator>
      <creatorName>Diong, Christina</creatorName>
      <givenName>Christina</givenName>
      <familyName>Diong</familyName>
    </creator>
    <creator>
      <creatorName>Etches, Jacob</creatorName>
      <givenName>Jacob</givenName>
      <familyName>Etches</familyName>
    </creator>
    <creator>
      <creatorName>Garber, Gary</creatorName>
      <givenName>Gary</givenName>
      <familyName>Garber</familyName>
    </creator>
    <creator>
      <creatorName>Johnstone, Jennie</creatorName>
      <givenName>Jennie</givenName>
      <familyName>Johnstone</familyName>
    </creator>
    <creator>
      <creatorName>Langford, Bradley</creatorName>
      <givenName>Bradley</givenName>
      <familyName>Langford</familyName>
    </creator>
    <creator>
      <creatorName>Daneman, Nick</creatorName>
      <givenName>Nick</givenName>
      <familyName>Daneman</familyName>
    </creator>
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  <titles>
    <title>Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study</title>
  </titles>
  <publisher>Zenodo</publisher>
  <publicationYear>2019</publicationYear>
  <dates>
    <date dateType="Issued">2019-11-25</date>
  </dates>
  <resourceType resourceTypeGeneral="Text">Journal article</resourceType>
  <alternateIdentifiers>
    <alternateIdentifier alternateIdentifierType="url">https://zenodo.org/record/3666980</alternateIdentifier>
  </alternateIdentifiers>
  <relatedIdentifiers>
    <relatedIdentifier relatedIdentifierType="DOI" relationType="IsIdenticalTo">10.1017/ice.2019.283</relatedIdentifier>
  </relatedIdentifiers>
  <rightsList>
    <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights>
  </rightsList>
  <descriptions>
    <description descriptionType="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.   

Design: The cohort included adult acute-care facility stays of ≥3 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.   

Results: 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], 0.97–1.24; proportional change in variance [PCV], −2.0%). Incidence-weighted (RR per doubling, 1.18; 95% CI, 1.06–1.30; PCV, −8.4%) and C. difficile case importation (RR per doubling, 1.43; 95% CI, 1.29–1.58; PCV, −30.1%) were strongly associated with C. difficile infection incidence.   

Conclusions: 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.</description>
  </descriptions>
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