Latest research provides new opportunities for clinical laboratories to demonstrate how testing can help curb hospital-acquired infections
Pathologists, microbiologists, and other healthcare providers have long been aware that hospital patients taking antibiotics are at higher risk of contracting the potentially deadly Clostridium difficile infection (C. diff). But new research adds an interesting twist to this issue.
Recent research indicates that being a “second user” of a bed may be another risk factor for acquiring the disease. This will give clinical laboratory professionals, microbiologists, and others on the front lines of hospital infection control programs another factor to consider when working to halt the spread of hospital-acquired infections (HAIs).
The recent study was published online in JAMA Internal Medicine. It shows that patients put in a hospital bed previously occupied by someone given antibiotics are 22% more likely to develop the C. difficile infection, even if they do not themselves receive antibiotics.
Antibiotics Connected to Increased Risk for C. diff Infection in Hospitals
C. difficile is one of the most common hospital-borne illnesses, causing a potentially life-threatening form of diarrhea. The Centers for Disease Control and Prevention (CDC) estimates there were a half a million C. diff infections in 2011, leading to 29,000 deaths within 30 days of the initial diagnosis.
The JAMA Internal Medicine study examined 100,615 pairs of patients at four New York hospitals who occupied the same hospital bed between 2010 and 2015. Those placed in beds previously belonging to a patient on antibiotics had a 0.72% chance of developing C. diff-caused diarrhea, compared with 0.43% risk among those whose bed was not previously used by a patient prescribed antibiotics. Prior patients who used the bed for less than 24 hours were excluded from the study, as were those who had a recent C. diff infection.
Because patients can carry C. diff without having any symptoms, study lead author Daniel Freedberg, MD, MS, a gastroenterologist at Columbia University Medical Center in New York, posited that antibiotics likely cause the C. diff within gut microbiome to expand, causing those patients to shed more spores on the bed and elsewhere in a hospital room.
“The next patient who enters the room is thus more likely to be exposed to C. diff spores,” Freedberg stated in a Reuters Health article. “It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time.”
While the risk of “second-user” patients contracting C. diff was less than 1%, Freedberg and his colleagues note the overuse of antibiotics raises the significance of their findings.
“Our results show that antibiotics can potentially cause harm to patients who do not themselves receive antibiotics and thus emphasize the value of antibiotic stewardship,” the study’s authors conclude in a Medical News Today article.
Antimicrobial Stewardship Program Requirements
Kevin Brown, PhD, of the University of Toronto Dalla Lana School of Public Health estimates about half of patients in acute care facilities typically are prescribed antibiotics.
“That’s a huge portion of patients that could be involved in spreading the infection,” stated Brown in the Reuters Health article.
Because the overuse and inappropriate use of antibiotics is now considered one of the biggest problems in medicine, the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission are adding antimicrobial stewardship program requirements to their respective hospital accreditation programs. Hospitals must meet a Jan. 1, 2017, deadline to put effective antimicrobial stewardship programs in place.
However, Jack A. Gilbert, PhD, Faculty Director of the Microbiome Center at the University of Chicago, suggests more research is needed before hospitals revise infection control procedures due to this potential new bed-induced risk.
“I think this evidence needs to be taken just as an association that needs further exploration,” Gilbert stated in the Reuters Health article. “While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable.”
Gilbert is correct to note that the study findings are of an association. At the same time, the study represents one more example of how improved analytics capabilities, and access to large volumes of electronic patient health data, are making more of these types of associations. In turn, as researchers probe these associations, they will identify new risk factors trigger infections in patients. This knowledge will enable clinical pathologists and microbiologists to offer improved diagnostic tests that contribute to improved patient care.
—Andrea Downing Peck