478. Improving Acid Suppression Therapy to Reduce Hospital-Onset C. difficile infection (HO-CDI): Impact of a Novel Analytic Application

Abstract

BackgroundProton pump inhibitors (PPIs) are among the most widely used classes of drugs, especially in the elderly, who are also at higher risk for CDI. Acid suppression therapy, especially using PPIs, has been shown to increase the risk of CDI. As part of an institutional effort to reduce HO-CDI, we developed an analytic application to support PPI stewardship.MethodsWe conducted this study in a 2-hospital, >1,100-bed community-based academic healthcare system in northern Delaware. We created a CDI-specific analytic application using the Health Catalyst analytics platform, over the existing data warehouse (Cerner), using 2016–2018 data (figure). The application refreshes daily and is able to provide near real-time patient data, including PPI and antibiotic use. We aimed to describe current PPI utilization patterns, calculate risk associated with PPI use adjusted for other risk factors for CDI, and measure the effect of interventions to decrease PPI use.ResultsAmong 133,592 total inpatient encounters from January 1, 2016 to April 22, 2018, 39,156 (29%) received PPIs and 1,146 (0.9%) had a positive PCR result for C. difficile. Among the C. difficile-positive encounters, PPIs were used in 486 (42%), with an adjusted OR of 2.1 (95% CI 1.7–2.6). Of encounters involving high-risk antibiotics who had a positive C. difficile PCR, 52% (255/486) were receiving PPIs. The services most likely to prescribe PPIs were internal medicine, orthopedic surgery and general surgery. Targeted chart review indicated that most inpatients receiving PPIs lacked an identified upper gastrointestinal (GI) disorder, and 37% were on the same PPI as outpatients prior to admission. Duration of therapy varied widely, but PPI courses were longer in patients diagnosed with CDI.ConclusionA novel application using existing health record data confirmed the increased risk of CDI due to PPI use, and identified important opportunities to decrease HO-CDI by limiting such use. Using this analytics platform provides near real-time data and will support rapid cycle improvements and allow for early evaluation of CDI interventions.Disclosures All authors: No reported disclosures.