Healthcare-associated Urinary Tract Infection (HA-UTI): A Risk Factor for Clostridioides Difficile Infection (CDI)? Results of a Real-world Data (RWD) Analysis

Abstract

<h3>Background</h3> It is estimated that 223,900 cases of CDI occur annually in hospitalized patients resulting in 12,800 deaths and $1 billion in attributable costs. Antimicrobial use is a risk factor for CDI. Antimicrobials ordered for UTI have been identified as a factor in both recurrent CDI and community-acquired CDI. This RWD analysis seeks to explore the relationship between HA-UTI and hospital-onset CDI (HO-CDI). <h3>Methods</h3> An electronic infection surveillance system was the source of de-identified RWD from 290 hospitals. Algorithmically-derived measures of healthcare-associated infections (ADM-HAIs), and records of all-cause antimicrobial orders (AOs), for all inpatient admissions for the period 10/1/18–9/30/19 were analyzed. All patients who presented with a urine ADM-HAI suggestive of HA-UTI and no other healthcare-associated infection (Urine+ patients), were observed for subsequent HO-CDI. Urine+ patients were compared to patients with no HAI of any type, other than CDI (HAI-free patients), and relative risk (RR) was estimated. The analysis was repeated for the subgroup of patients who received an AO for any reason during their stay. <h3>Results</h3> 3,050,525 inpatient admissions were analyzed. 26,634 were identified as Urine+ patients. 188 of those patients subsequently presented with HO-CDI. 2,978,507 were identified as HAI-free patients. 6,238 of those patients presented with HO-CDI. The incidence of HO-CDI was significantly higher in Urine+ patients compared to HAI-free patients (RR=3.37, 95% CL[2.92, 3.89], p<0.0001). When the analysis was repeated to examine only patients who received AOs, Urine+ patients continued to be at higher risk of subsequent HO-CDI compared to HAI-free patients (RR=3.28, 95% CL[2.74,3.92], p<0.0001). <h3>Conclusions</h3> The presence of a urine ADM-HAI, suggestive of HA-UTI, was associated with an increased risk of subsequent HO-CDI. This held when only patients with AOs were considered. These observations mirror findings from other published studies, however, other factors may have contributed to increased risk for both HA-UTI and HO-CDI.