C. Difficile Rates and Antibiotic Usage

The VHHA Quality and Patient Safety Advisory Council recently conducted a review of regional C.difficile data throughout Virginia. C. difficile is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. The bacterium can be found in any environment, including hospitals, post-acute, and long-term care facilities where people are more likely to carry the bacteria, which is commonly found on the surface of bedside tables, door knobs, counters, bathrooms, and sinks.1 According to the Centers for Disease Control and Prevention (CDC), C.difficile is the most common bacteria responsible for health care-associated infections (HAI) in hospitals in the U.S., and it may account for 14,000 deaths annually.2 The bacterium can spread between patients in contact with contaminated objects, or from the hands of health care workers. When a patient is taking an antibiotic for an infection, the drug kills both the bacteria causing the infection as well as the “good” bacteria that helps protect the body from other infections. Without “good” bacteria in the intestines, the body is an optimal environment for C.difficile to grow.1 The misuse of antibiotics – for instance, extended or duplicative use – is a common medication-associated risk factor for C.difficile.1 Research suggests that hospital patients taking antibiotics are, on average, 60 percent more likely to acquire the infection.3 The VHHA Analytics team conducted a regional aggregation between the incidence of C.difficile rates and antibiotic prescription rates to determine if there is a relationship at the regional level. Prescription claims data from 2015 accessed through the All-Payer Claims Database (APCD) details claims for the privately insured, and Medicare and Medicaid populations. The claims database covers 99 percent of Medicare and Medicaid claims and 50-55 percent of private insurance claims. It does not include claims related to care for uninsured patients or those in the workers’ compensation population. Prescriptions written for less than 30 days were excluded from this analysis. C.difficile data was accessed from the National Healthcare Safety Network (NHSN), a health care-associated infection tracking system. The analysis shows that at the regional level there is no direct correlation between the prevalence of C.difficile and antibiotic prescription drug claims in 2015. The VHHA Analytics team will perform a comparative analysis when 2016 data becomes available. (3/16)

1 https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691
2 http://www.foodsafetynews.com/2014/09/over-use-of-antibiotics-by-hospitals-turns-c-into-the-deadly-diarrhea/#.Wqgb9lV95hF
3 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2130725#ioi140154r1