803 - Risk factors associated with Clostridioides difficile infection in hospitalized patients with community-acquired pneumonia

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Presenting Author(s)

William Justin Moore

ID Clinical Pharmacist
Northwestern Medicine
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CJ

Caroline C. Jozefczyk

Antimicrobial Stewardship & Infectious Diseases Pharmacist
Ohio Health
Mansfield, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PY

Paul R. Yarnold

President
Optimal Data Analysis LLC
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KH

Karolina Harkabuz

PharmD Candidate
Midwestern Univeristy Chicago College of Pharmacy
Palos Hills, IL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VW

Valerie Widmaier

Senior Medial Technologist
Northwestern Memorial Hospital
Park Ridge, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CS

Christina Silkaitis

Director Infection Prevention and Epidemiology
Northwestern Medicine
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CQ

Chao Qi

Associate Professor
Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital
Chicago, IL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Richard G. Wunderink

Professor of Medicine, Pulmonary and Critical Care
Northwestern University Feinberg School of Medicine
Chicago, IL
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Sarah Sutton

Infectious Diseases Physician, Antimicrobial Stewardship Medical Director
Northwestern University
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MP

Michael J. Postelnick

Senior Infectious Diseases Pharmacist, Antimicrobial Stewardship Practice Coordinator
Northwestern Memorial Hospital, Huntley Hospital, McHenry Hospital
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TZ

Teresa Zembower

Infectious Diseases Physician, Microbiology Laboratory Associate Director
Northwestern University
Chicago, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Nathaniel J. Rhodes

Associate Professor
Midwestern University
Downers Grove, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Patients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP.

Methods: Design: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1).

Results: A total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s< 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%).

Conclusion: We identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted.