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Activity Number: 648
Type: Contributed
Date/Time: Thursday, August 8, 2013 : 8:30 AM to 10:20 AM
Sponsor: Section on Statistics in Epidemiology
Abstract - #309742
Title: Modeling the Duration of Effects of Antibiotic Exposures on the Risk of Clostridium Difficile Infection (CDI): A Comparison of Methods
Author(s): Kevin Brown*+ and David Fisman and Rahim Moineddin and Nick Daneman
Companies: and University of Toronto and University of Toronto and University of Toronto
Keywords: Proportional hazards ; Weighted cumulative exposures ; Cox regression ; Time-varying effects ; Latent period ; Infection transmission
Abstract:

Antibiotic use is the main risk factor for Clostridium difficile infection (CDI), but the cumulative nature and time-course of effects of antibiotic use are not well understood. For all patients in a Toronto hospital over a 2 year period, patient risk factors, hospital pharmacy records and the timing of case onset were obtained from hospital records. Receipt of any antibiotic therapy was measured for each patient-day. Time-varying antibiotic effects were estimated using a Cox model; 14 different weighted cumulative exposure and spline functions were used. The best fitting exposure effects suggested that the hazards were constant during antimicrobial therapy and that cessation of antibiotics was followed by an increase in risk for 2 days, which was subsequently followed by a rapid decline to zero over the next 12 days (?2 3df = 10.01, p=0.02). After adjustment for age and hospitalization history, a 7 day antibiotic course was associated with 2-fold increase in average risk. Proportional hazards regression with time-varying effects yielded insight into the etiology of CDI and should be used more frequently for studies of hospital infections.


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