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연세대학교 의과대학

J. Microbiol. Immunol. Infect., 2023 Jun 16;S1684-1182(23)00117-2 | https://doi.org/10.1016/j.jmii.2023.06.003 Potential causal effect of contact precautions and isolation on Clostridioides difficile infection in the hyperendemic setting: Interrupted time-series analyses before and after implementation

Eun Hwa Lee ^a,1, Hye Sun Lee ^b,1, Kyoung Hwa Lee ^a, Young Goo Song ^a, Sang Hoon Han ^a,c

^aDivision of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
^bBiostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
^cInstitute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Republic of Korea

¹These authors contributed equally to this work.
Corresponding author : Sang Hoon Han

Abstract

Background: Recent studies disputed the effectiveness of efforts to comply with contact precautions and isolation (CPI) considering relatively low intra-hospital transmission rate of healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). We evaluated the potential causal effect of CPI on HCFA-CDI occurrence by comparing the incidence rate (IR) for different time periods with and without CPI implementation.

Methods: Long-term observational time-series data were separated into three periods (pre-CPI: January 2012-March 2016, CPI: April 2016-April 2021, post-CPI: May 2021-December 2022). CPI was suspended owing to the restriction of isolation rooms during the COVID-19 pandemic. We inferred potential causal outcomes by comparing predicted and observed IRs of HCFA-CDI using interrupted time-series analyses, including the Bayesian structural time-series or autoregressive integrated moving average (ARIMA) model in the R-language or SAS software.

Results: The monthly observed IR (44.9/100,000 inpatient-days) during the CPI period was significantly lower than the predicted IR (90.8) (-50.6% relative effect, P = 0.001). However, the observed IR (52.3) during the post-CPI period was significantly higher than the predicted IR (39.1) (33.6%, P = 0.001). The HCFA-CDI IR decreased during CPI (-14.3, P < 0.001) and increased post-CPI (5.4, P < 0.001) in the multivariable ARIMA model, which controlled for antibiotic usage, handwashing with soap and water, and number of toxin tests.

Conclusions: Various time-series models revealed that CPI implementation had a potential causal effect on the reduction of HCFA-CDI incidence.

논문정보

형식Research article
게재일2023년 06월 (BRIC 등록일 2023-07-28)
연구진국내 연구진
분야 생명과학 > 감염생물학

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