Open Forum Infect DisOpen Forum Infect DisofidOpen Forum Infectious Diseases2328-8957Oxford University PressUS563228510.1093/ofid/ofx162.171ofx162.171AbstractsOral AbstractAssociation of Hospital-Onset Clostridium difficile Infection Rates and Antibiotic Use in US Acute Care Hospitals, 2006–2012: An Ecologic AnalysisKazakovaSophiaMD, MPH, PhD1BaggsJamesPhD1McDonaldLawrenceMD1YiSarahPhD1HatfieldKellyMSPH1GuhAliceMD, MPH1ReddySujanMD1JerniganJohn A.MD, MS1 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Session: 28. CDI Prevention

Thursday, October 5, 2017: 8:30 AM

Fall201704102017041020174Suppl 1ID Week 2017 AbstractsS1S1© The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.2017This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.comAbstractBackground

This study investigated the association between facility-level rates of hospital-onset CDI (HO-CDI) and inpatient antibiotic use (AU) in a large group of U.S. acute care hospitals over a 7-year period.

Methods

We used adult discharge and antibiotic use data from 552 acute care hospitals participating in the Truven Health MarketScan Hospital Database from January 1, 2006 to December 31, 2012 to determine facility-level CDI rates and AU. HO-CDI was defined as a discharge with a secondary ICD-9-CM diagnosis code for CDI (008.45) and inpatient treatment with metronidazole or oral vancomycin. The relationship between facility-level HO-CDI (HO-CDI per 10,000 patient-days (PD)) and AU (days of therapy (DOT) per 1,000 PD) was examined through multivariate general estimating equation models that accounted for the correlation between annual HO-CDI rates within a hospital. The models controlled for hospital characteristics and a facility-level rate of community-onset CDI (CO-CDI), defined as a discharge with a primary ICD-9-CM code for CDI and inpatient treatment.

Results

During 2006 to 2012, the mean HO-CDI rate was 11 per 10,000 PD (interquartile range (IQR): 5.7–14.7) and mean AU was 811 DOT/1,000 PD (IQR: 710–932). After controlling for facility-level CO-CDI and other hospital characteristics, overall AU was significantly associated with facility-level HO-CDI rate; for every 50 DOT/1,000 PD increase in AU, there was a 4.4% increase in the HO-CDI rate. Similarly, the only antibiotic classes significantly associated with HO-CDI were third- and fourth-generation cephalosporins (P < 0.0001) and carbapenems (P = 0.0011) with respective increases of 2.1% and 2.4% of HO-CDI per 10 DOT/1,000 PD increase. Fluoroquinolones and β-lactam/β-lactamase inhibitor combinations were not significantly associated with HO-CDI.

Conclusion

In this ecologic analysis of over 500 hospitals, overall antibiotic use was associated with increased rates of HO-CDI. In contrast to recent patient-level analyses in the United States and national observations in England, only third- and fourth-generation cephalosporins and carbapenems were associated with HO-CDI.

Disclosures

All authors: No reported disclosures.