Herd Effect on Clostridium Difficile Infection Rates

Although risk factors for C diff are well-known, there are variations between hospitals that cannot be explained by individual factors.
Retrospective nested case-control study of VA long-term care facilities between 2006-2012.
n = 6012 CDI cases in 5499 residents in 86 different “care regions” in the VA system.
CDI incidence across regions varied more than 48-fold.
Patient-level factors:
– acute-care hospitalization
– recent abx use
– number of comorbidities
– recent PPI use
Two independent risk factors predicted regional rates:
– regional abx use (varied by more than 6-fold)
– importation of acute-care CDI into chronic care (varied by >100-fold)
Non-antibiotic users in regions with high abx use had higher risk for CDI than non-abx users in low-use areas.
Summary:  confirms “herd effect” of CDI risk if pts were hospitalized in region with high rate of abx use.
Ann Intern Med 2016 Apr 19

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