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Original Investigation
Less Is More
December 2016

Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed

Author Affiliations
  • 1Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
  • 2Department of Biomedical Informatics, New York-Presbyterian Hospital, New York, New York
  • 3Department of Epidemiology, Mailman School of Public Health, School of Nursing, Columbia University, New York, New York
JAMA Intern Med. 2016;176(12):1801-1808. doi:10.1001/jamainternmed.2016.6193
Key Points

Question  Is the receipt of antibiotics by prior hospital bed occupants associated with risk for Clostridium difficile infection (CDI) in subsequent patients who occupy the same bed?

Findings  In this cohort study, receipt of antibiotics by prior patients was associated with a 22% relative increase in risk for CDI in subsequent patients who occupied the same bed. Aside from antibiotics, no other factors related to the prior bed occupants were associated with increased risk for CDI in subsequent patients.

Meaning  Antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk for CDI.

Importance  Antibiotics are the crucial risk factor for CDI, but it is unknown how one hospitalized patient’s receipt of antibiotics may affect risk for CDI for a different patient within the same environment.

Abstract

Objective  To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed.

Design, Setting, and Participants  This is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours.

Main Outcomes and Measures  The primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported.

Results  Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P < .01). This relationship remained unchanged after adjusting for factors known to influence risk for CDI including receipt of antibiotics by the subsequent patient (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.02-1.45) and also after excluding 1497 patient pairs among whom the prior patients developed CDI (aHR, 1.20; 95% CI, 1.01-1.43). Aside from antibiotics, no other factors related to the prior bed occupants were associated with increased risk for CDI in subsequent patients.

Conclusions and Relevance  Receipt of antibiotics by prior bed occupants was associated with increased risk for CDI in subsequent patients. Antibiotics can directly affect risk for CDI in patients who do not themselves receive antibiotics.

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