Epidemiology and prevention of clostridioides difficile infection at a single military treatment facility in Hawai‘i

Abstract

Clostridioides difficile (C. difficile) is a bacterium that can cause gastrointestinal infection and is considered an urgent threat to public health by the Centers for Disease Control and Prevention. C. difficile infection is the most common cause of antibiotic-associated diarrhea and is one of the most common healthcare-associated infections in the United States. Though estimated cases of C. difficile requiring hospitalization or affecting already hospitalized patients have decreased over the last decade, prevention of C. difficile infection continues to be a major initiative for healthcare facilities throughout the nation. With the advent of highly sensitive laboratory tests to detect C. difficile, diagnostic stewardship is also a key initiative to mitigate unnecessary testing, overdiagnosis, and overreporting of C. difficile. This dissertation presents an analysis of risk factors for C. difficile infection, healthcare-facility onset (HO) C. difficile infection, and impact of implementing a clinical decision support tool on HO C. difficile infection and diagnostic stewardship practices at a single military treatment facility in Hawai‘i. Study 1 found that diarrhea, antibiotics, fever, and end-stage renal disease were statistically significantly associated with C. difficile infection. Study 2 did not find statistically significant associations in the multivariable model but noted potential associations with racial/ethnic findings, recent laxative use, and proton pump inhibitor use that warrant further research. Study 3 found a higher prevalence ratio of HO C. difficile infection after implementation of the clinical decision support tool but promising improvements to diagnostic stewardship practices, particularly in regard to case ascertainment.