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摘要
The main objective of this study was to determine patient- and hospital-level medication risk factors associated with Clostridium difficile infection (CDI) occurrence among patients clustered within hospitals using a multilevel model. Patients with healthcare-associated (HA)-CDI were identified from among 64 academic medical centres in 2009. A frequency match was conducted; for each case, up to two controls were selected, matched on similar pre-infection length of stay and clinical service line. Patient- and hospital-level medication use, including antibacterial and gastric acid-suppressant agents, was assessed using a two-level logistic regression model. A total of 5967 CDI cases and 8167 controls were included in the analysis. The odds of acquiring HA-CDI increased with the following medications [OR (95 CI)]: anti-methicillin-resistant Staphylococcus aureus agents [1.38 (1.221.56)]; third- or fourth-generation cephalosporins [1.75 (1.621.89)]; carbapenems [1.60 (1.441.79)]; -lactam/-lactamase inhibitor combinations [1.49 (1.361.64)]; vancomycin [1.73 (1.571.89)]; and proton pump inhibitors [1.43 (1.301.57)]. The odds of acquiring HA-CDI decreased with the following medications: clindamycin [0.74 (0.630.87)]; and macrolides [0.88 (0.770.99)]. Controlling for patient-level covariates, no hospital-level medication covariates that we analysed had statistically significant effects on HA-CDI. The odds of acquiring HA-CDI increased with the hospital proportion of patients aged 65 years [1.01 (1.001.02)]. We found several medications that were associated with the risk of patients developing HA-CDI, including -lactam/-lactamase inhibitor combinations, third- or fourth-generation cephalosporins, carbapenems, vancomycin, proton pump inhibitors and anti-methicillin-resistant S. aureus agents. There were no medication effects significant at the hospital level.
- 出版日期2014-4
