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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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{
  "description": "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.", 
  "license": "", 
  "creator": [
    {
      "@id": "https://orcid.org/0000-0002-1483-2188", 
      "@type": "Person", 
      "name": "Brown, Kevin A."
    }, 
    {
      "@type": "Person", 
      "name": "McGeer, Allison"
    }, 
    {
      "@type": "Person", 
      "name": "Schwartz, Kevin L."
    }, 
    {
      "@type": "Person", 
      "name": "Diong, Christina"
    }, 
    {
      "@type": "Person", 
      "name": "Etches, Jacob"
    }, 
    {
      "@type": "Person", 
      "name": "Garber, Gary"
    }, 
    {
      "@type": "Person", 
      "name": "Johnstone, Jennie"
    }, 
    {
      "@type": "Person", 
      "name": "Langford, Bradley"
    }, 
    {
      "@type": "Person", 
      "name": "Daneman, Nick"
    }
  ], 
  "headline": "Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study", 
  "image": "https://zenodo.org/static/img/logos/zenodo-gradient-round.svg", 
  "datePublished": "2019-11-25", 
  "url": "https://zenodo.org/record/3666980", 
  "@context": "https://schema.org/", 
  "identifier": "https://doi.org/10.1017/ice.2019.283", 
  "@id": "https://doi.org/10.1017/ice.2019.283", 
  "@type": "ScholarlyArticle", 
  "name": "Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study"
}
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