151 Teaching Hospitals Have Lower Adjusted Rates of Hospital-Onset C. difficile Infection Compared to Non-Teaching Hospitals

Abstract

INTRODUCTION: Hospital-onset Clostridioides difficile infection (HoCDI) is a preventable but significant cause of morbidity among patients hospitalized at teaching hospitals (THs; Consumer Reports 2016). Prior research that did not adjust for patients' disease severity demonstrated higher HoCDI rates in THs compared to non-THs (Open Forum Inf Dis 2016, 3(suppl_1):2062). We therefore attempted to determine the impact of hospital teaching status (HTS) on HoCDI rates while adjusting for underlying disease severity using the Vizient clinical database. METHODS: In this cross-sectional study, we used the Vizient database to analyze all adult hospitalizations from 10/1/2014 to 3/31/2018. Vizient includes >90% of academic centers and their affiliated community hospitals in the US. Vizient hospitals (n = 369) were grouped into major THs (members of Council of THs), minor THs (medical school affiliation only), and non-THs (all other hospitals), as defined by the 2016 American Hospital Association (AHA) Survey. We excluded hospitals missing from the AHA survey and discharges to another hospital or against medical advice. We used multivariable linear regression (MVLR) of aggregated data to assess the impact of HTS on HoCDI rates while adjusting for demographics, comorbidities, severity of illness indices, case mix, and hospital factors. MVLR was also performed using hospital resident-to-bed ratios (RTBR) to reflect teaching intensity. Final models were generated using step-wise backward elimination of covariates using P < 0.05. RESULTS: We identified 18,247,643 hospitalizations among 337 hospitals (132 major THs, 110 minor THs, 95 non-THs) from 10/1/2014 to 3/31/2018. Hospitalization characteristics are presented in Table 1. Unadjusted rates of HoCDI were higher in major THs compared to non-THs (median 0.4% vs. 0.2%, P < 0.01). After MVLR to adjust for confounders, major and minor HTS (Table 2) and RTBR (Table 3) were negatively correlated with HoCDI. Because mean length of stay and ICU stay reflect not only disease severity but also effects of HoCDI, they were added separately to the final models and the negative correlations between HTS and HoCDI persisted. CONCLUSION: After adjusting for metrics of disease severity and complexity, THs may have lower rates of HoCDI compared to non-THs. Additional research is needed to determine how inpatient practices that may contribute to HoCDI differ in THs vs. non-THs.