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Journal article
Estimating the impact of patient-level risk factors and time-varying hospital unit on healthcare-associated Clostridioides difficile infection using cross-classified multilevel models
Infection control and hospital epidemiology, v 47(2), pp 145-152
Feb 2026
PMID: 41321162
Featured in Collection : Research Supported by Drexel Libraries' OA Programs
Abstract
Objective:
To deconstruct the multiple levels of risk factors for Clostridioides difficile infection, using multilevel models (MLMs) accounting for patient movement.
Study Design and Setting:
Case-control study of patients hospitalized in three acute care Delaware hospitals, December 2019–December 2023.
Patients:
Cases were patients aged ≥18 years who tested positive for hospital-onset C. difficile infection. Controls were patients aged ≥18 years hospitalized more than 72 hours, who did not test positive for C. difficile infection.
Methods:
Hierarchical and cross-classified MLMs were used to calculate odds of C. difficile infection based on patient-level risk factors and to evaluate the variation in odds of infection attributable to environmental risk factors using the hospital unit(s) a patient was assigned to during hospitalization.
Results:
Our study included 1,223 patients (249 cases, 974 controls). In both models, greater odds of infection were associated with antibiotic exposure [adjusted odds ratio (aOR) = 11.20, 95% confidence interval (CI) = 7.19, 17.40; aOR = 12.80, 95% CI = 8.46, 19.40 for hierarchical and cross-classified models respectively] and health insurance (aOR = 1.74, 95% CI = 1.12, 2.68; aOR = 1.62, 95% CI = 1.03, 2.53; public vs. private). Median odds ratios (MOR) for both models indicated greater relevance of between-unit heterogeneity in the outcome than health insurance but less than antibiotic exposure (MOR = 1.83, 95% CI = 1.56, 2.30 and 2.71 95% CI = 2.10, 4.06).
Conclusion:
Using multilevel methods accounting for patient movement, we found that while antibiotic use is the most important risk factor in patients that developed C. difficile infection, environmental risk factors are additionally important and should be considered in research involving hospitalized patients and healthcare-associated infections.
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Details
- Title
- Estimating the impact of patient-level risk factors and time-varying hospital unit on healthcare-associated Clostridioides difficile infection using cross-classified multilevel models
- Creators
- Jessica Lynn Webster (Corresponding Author) - Drexel UniversityClaudine T. Jurkovitz - Christiana Care Health SystemBrisa N. Sanchez - Drexel UniversityStephen C. Eppes - Christiana Care Health SystemNeal Goldstein - Drexel University, Epidemiology and Biostatistics
- Publication Details
- Infection control and hospital epidemiology, v 47(2), pp 145-152
- Publisher
- Cambridge University Press
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Epidemiology and Biostatistics
- Web of Science ID
- WOS:001627390000001
- Scopus ID
- 2-s2.0-105023282711
- Other Identifier
- 991022135142104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Infectious Diseases
- Public, Environmental & Occupational Health