title: Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts.
abstract: BACKGROUND
  Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI.
  
  
  OBJECTIVE
  To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education.
  
  
  METHODS
  We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission. Using Cox regression, we constructed a score to identify patients at high risk for CDI on the basis of preadmission characteristics. We calculated and plotted the observed six-month CDI risk for each decile of predicted risk.
  
  
  RESULTS
  We identified 721 CDIs following 54,186 hospital admissions-a 6-month incidence of 13.3 CDIs/1000 patient admissions. Patients with the highest predicted risk of CDI had an observed incidence of 53 CDIs/1000 patient admissions. The score differentiated between patients who do and do not develop CDI, with values for the extended C-statistic of 0.75. Predicted risk for CDI agreed closely with observed risk.
  
  
  CONCLUSIONS
  Our risk score accurately predicted six-month risk for CDI using preadmission characteristics. Accurate predictions among the highest-risk patient subgroups allow for the identification of patients who could be targeted for and who would likely benefit from review of inpatient antibiotic use or enhanced educational efforts at the time of discharge planning.
authors: Investigator at The Center for Health Research in Portland, OR. jennifer.l.kuntz@kpchr.org.
authors: Jennifer L
authors: JL
authors: Kuntz
authors: Senior Investigator at The Center for Health Research in Portland, OR. david.h.smith@kpchr.org.
authors: David H
authors: DH
authors: Smith
authors: Research Associate at The Center for Health Research in Portland, OR. amanda.f.petrik@kpchr.org.
authors: Amanda F
authors: AF
authors: Petrik
authors: Research Analyst at The Center for Health Research in Portland, OR. xiuhai.yang@kpchr.org.
authors: Xiuhai
authors: X
authors: Yang
authors: Nephrologist for Northwest Permanente in Portland, OR. micah.l.thorp@kp.org.
authors: Micah L
authors: ML
authors: Thorp
authors: Infectious Disease Pharmacist at the Sunnyside Medical Center in Clackamas, OR. tracy.a.barton@kp.org.
authors: Tracy
authors: T
authors: Barton
authors: Infectious Disease Pharmacist at the Sunnyside Medical Center in Clackamas, OR. karen.l.barton@kpchr.org.
authors: Karen
authors: K
authors: Barton
authors: Infectious Disease Pharmacist at the Sunnyside Medical Center in Clackamas, OR. matthew.j.labreche@kp.org.
authors: Matthew
authors: M
authors: Labreche
authors: Infectious Disease Specialist at the Sunnyside Medical Center in Clackamas, OR. steven.j.spindel@kp.org.
authors: Steven J
authors: SJ
authors: Spindel
authors: Investigator at The Center for Health Research in Portland, OR. eric.s.johnson@kpchr.org.
authors: Eric S
authors: ES
authors: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010343:Patient Admission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012308:Risk Management; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents