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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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  <dc:creator>Brown, Kevin A.</dc:creator>
  <dc:creator>McGeer, Allison</dc:creator>
  <dc:creator>Schwartz, Kevin L.</dc:creator>
  <dc:creator>Diong, Christina</dc:creator>
  <dc:creator>Etches, Jacob</dc:creator>
  <dc:creator>Garber, Gary</dc:creator>
  <dc:creator>Johnstone, Jennie</dc:creator>
  <dc:creator>Langford, Bradley</dc:creator>
  <dc:creator>Daneman, Nick</dc:creator>
  <dc:date>2019-11-25</dc:date>
  <dc: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.   

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.</dc:description>
  <dc:identifier>https://zenodo.org/record/3666980</dc:identifier>
  <dc:identifier>10.1017/ice.2019.283</dc:identifier>
  <dc:identifier>oai:zenodo.org:3666980</dc:identifier>
  <dc:rights>info:eu-repo/semantics/openAccess</dc:rights>
  <dc:title>Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study</dc:title>
  <dc:type>info:eu-repo/semantics/article</dc:type>
  <dc:type>publication-article</dc:type>
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