780 - How Much Does Prior Hospitalization Contribute to Readmission with Community-onset Clostridioides difficile Infection?

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Presenting Author(s)

Alice Guh

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

LK

Lauren C. Korhonen

C. difficile Surveillance Coordinator
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lisa Gail Winston

Professor
UCSF
San Francisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BM

Brittany Martin

Epidemologist
California Emerging Infections Program
Oakland, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HJ

Helen Johnston

Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GB

Geoffrey Brousseau

Epidemologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EB

Elizabeth Basiliere

Epidemologist
Colorado Department of Public Health and Environment
Denver, Colorado
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DO

Danyel M. Olson

C. difficile Infection Project Coordinator
Connecticut Emerging Infections Program, Yale School of Public Health
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Scott Fridkin

Professor
Georgia Emerging Infections Program, Decatur, GA; Emory University School of Medicine, Atlanta, GA
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LW

Lucy E. Wilson

Professor
University of Maryland Baltimore County
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RP

Rebecca Perlmutter

Epidemiologist
Maryland Department of Health
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SH

Stacy Holzbauer

Career Epidemiology Field Officer
Minnesota Department of Health
St Paul, Minnesota
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Maria Bye

Epidemiologist
Minnesota Department of Health
St. Paul, Minnesota
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EP

Erin C. Phipps

Principal Investigator, CDI/MuGSI/Candidemia Surveillance
University of New Mexico, Albuquerque, NM; New Mexico Emerging Infections Program, Santa Fe, NM
Albuquerque, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KF

Kristina Flores

Surviellance Officer
University of New Mexico, New Mexico Emerging Infections Program
Albuquerque, New Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ghinwa Dumyati

Professor
New York Emerging Infections Program and University of Rochester Medical Center
Rochester, New York
Disclosure: Roche Diagnostics (Consultant)
DN

Deborah Nelson

Epidemologist
New York Emerging Infections Program and University of Rochester Medical Center
Rochester, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TH

Trupti T. Hatwar

Epidemiologist
University of Rochester Medical Center
Rochester, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
VO

Valerie Ocampo

HAI Public Health Nurse
Oregon Health Authority
Portland, Oregon
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MK

Marion Kainer

Epidemologist
Western Health
Melbourne, Victoria, Australia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Clifford McDonald

Associate Director for Science
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Interventions to reduce community-onset (CO) Clostridioides difficile Infection (CDI) are not usually hospital-based due to the perception that they are often acquired outside the hospital. We determined the proportion of admitted CO CDI that might be associated with previous hospitalization.

Methods: The CDC’s Emerging Infections Program conducts population-based CDI surveillance in 10 US sites. We defined an incident case as a C. difficile-positive stool collected in 2017 from a person aged ≥ 1 year admitted to a hospital with no positive tests in the prior 8 weeks. Cases were defined as CO if stool was collected within 3 days of hospitalization. CO cases were classified into four categories: long-term care facility (LTCF)-onset if patient was admitted from an LTCF; long-term acute care hospital (LTACH)-onset if patient was admitted from an LTACH; CO-healthcare-facility associated (CO-HCFA) if patient was admitted from a private residence but had a prior healthcare-facility admission in the past 12 weeks; or community-associated (CA) if there was no admission to a healthcare facility in the prior 12 weeks. We excluded hospitals with < 10 cases among admitted catchment-area residents.

Results: Of 4724 cases in 86 hospitals, 2984 (63.2%) were CO (median per hospital: 65.8%; interquartile range [IQR]: 58.3%-70.7%). Among the CO cases, 1424 (47.7%) were CA (median per hospital: 48.1%; IQR: 40.3%-57.7%), 1201 (40.3%) were CO-HCFA (median per hospital: 41.0%; IQR: 32.9%-47.8%), 350 (11.7%) were LTCF-onset (median per hospital: 10.0%; IQR: 0.6%-14.4%), and 9 (0.3%) were LTACH-onset. Of 1201 CO-HCFA cases, 1174 (97.8%) had a prior hospitalization; among these, 978 (83.3%) (median per hospital: 83.3%; IQR: 69.2%-90.6%), which consists of 32.8% of all hospitalized CO cases, had been discharged from the same hospital (Figure), and 84.4% of the 978 cases (median per hospital: 88.2%: IQR: 76.5%-100.0%) had received antibiotics sometime in the prior 12 weeks.Figure. Frequency of Cases Discharged in the 12 Weeks Prior to Readmission with Clostridioides difficile Infection (N=1138*)

Conclusion: A third of hospitalized CO CDI had been recently discharged from the same hospital, and most had received antibiotics during or soon after the last admission. Hospital-based and post-discharge antibiotic stewardship interventions could help reduce subsequent CDI hospitalizations.