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Clostridioides difficile Infection in Rehabilitation Patients with Prior Urine Testing at a Large Academic Medical Center

Messina, Olivia (2019) Clostridioides difficile Infection in Rehabilitation Patients with Prior Urine Testing at a Large Academic Medical Center. Master Essay, University of Pittsburgh.

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Background: There is evidence that a significant portion of diagnosed UTI is asymptomatic bacteriuria (ASB), which does not require urine testing or treatment. Unnecessary urine testing of asymptomatic hospital patients can have downstream effects, including inappropriate use of antibiotics, that put patients at a higher risk of Clostridioides difficile infection (CDI). Previous research has identified rehabilitation as a hospital unit that may be prescribing unnecessary antibiotics following urine testing at a higher rate than other units.
Methods: This study sought to determine the differences between 193 patients tested for CDI within acute rehabilitation units of a large academic medical center depending on their prior urine testing status. Demographic and clinical data was extracted for patients who had CDI testing or positive urine testing at UPMC Mercy between 2016 and 2017. Patients outside of rehabilitation units were excluded from analysis. Data were stratified by prior urine testing status, and descriptive statistics and group differences were determined using appropriate statistical tests in SAS 9.4.
Results: There were no significant differences in age, race, length of stay, or CDI test result between patients with and without prior urine testing. 24.3% of patients positive for CDI had prior urine testing, and 100% of these infections were classified as hospital-associated. Significantly more females had prior urine testing compared to males, and significantly more patients with severe chronic conditions had prior urine testing compared to other conditions.
Conclusions: Additional research is needed to investigate hospital or physician practices that may contribute to CDI following urine testing, particularly because 100% of the identified infections were hospital-associated. Differences in sex are consistent with previous research showing that women are more likely to be tested for UTIs than men, which indicates a bias that should be addressed in infection control interventions. Future studies should collect data on comparable controls, as well as information on patient symptomology, antibiotic treatment, and the appropriateness of testing and treatment. Research on this topic is of great public health importance to help prevent the urgent public health threats of antibiotic resistance and CDI.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Messina, Oliviaorm10@pitt.eduorm10
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairHaggerty, Catherinehaggerty@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberMartinson, Jeremyjmartins@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberYassin, Mohamedyassinm@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 25 April 2019
Date Type: Submission
Number of Pages: 38
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 17 May 2019 19:17
Last Modified: 01 May 2022 05:15


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