000042915 001__ 42915 000042915 005__ 20240530124733.0 000042915 0247_ $$2doi$$a10.6083/bpxhc42915 000042915 037__ $$aETD 000042915 041__ $$aeng 000042915 245__ $$aThe role of antimicrobial stewardship in modifying the epidemiology of clostridioides difficile infection 000042915 260__ $$bOregon Health and Science University 000042915 269__ $$a2024-05-29 000042915 336__ $$aDissertation 000042915 502__ $$bPh.D. 000042915 502__ $$gEpidemiology 000042915 520__ $$aClostridioides difficile infection (CDI) causes nearly half a million diarrheal illnesses annually in the United States and is associated with a twofold increase in the risk of death for hospitalized patients with CDI. Broad spectrum antibiotic therapy is a major risk factor for CDI. As such, healthcare-associated (HA) CDI is often employed as a metric to evaluate antimicrobial stewardship programs (ASPs). However, because the risk from antibiotics is heterogeneous and dependent on a variety of other individual and environmental risk factors, evidence that HA-CDI is a quality metric for stewardship success is lacking. The objective of this dissertation is to achieve a more granular understanding of the risk of HA-CDI from antibiotics, and to evaluate the specific contexts where we would expect HA-CDI incidence to reflect changes in broad spectrum prescribing through stewardship interventions. 000042915 540__ $$fCC BY 000042915 542__ $$fIn copyright - single owner 000042915 650__ $$aClostridioides difficile$$029096 000042915 650__ $$aAntimicrobial Stewardship$$012178 000042915 650__ $$aEpidemiological Models$$013691 000042915 650__ $$aEpidemiology$$018518 000042915 650__ $$aRetrospective Studies$$025415 000042915 6531_ $$ahealthcare-associated infections 000042915 691__ $$aOHSU-PSU School of Public Health$$041366 000042915 7001_ $$aRay, Michael$$uOregon Health and Science University$$041354$$10000-0001-7670-9639 000042915 711__ $$uOregon State University College of Pharmacy 000042915 7201_ $$aMcGregor, Jessina$$uOregon Health and Science University$$041354$$eCommittee chair$$7Personal 000042915 7201_ $$aFuruno, Jon$$uOregon State University$$eCommittee member$$7Personal 000042915 7201_ $$aStrnad, Luke$$uOregon Health and Science University$$041354$$eCommittee member$$7Personal 000042915 7201_ $$aLofgren, Eric $$uWashington State University$$eCommittee member$$7Personal 000042915 789__ $$eHas part$$whttps://doi.org/10.1093/cid/ciae259$$2URL 000042915 792__ $$aRay, M.J., Strnad, L.C., Tucker, K.J., Furuno, J.P., Lofgren, E.T., McCracken, C.M., Park, H., Gerber, J.S., and McGregor, J.C., Influence of Antibiotic Exposure Intensity on the Risk of Clostridioides difficile Infection. Clinical Infectious Diseases, 2024. 000042915 8564_ $$9a66c7643-5b03-47fd-826b-2d8f20371b5f$$s1758720$$uhttps://digitalcollections.ohsu.edu/record/42915/files/Ray.Michael.2024.pdf 000042915 909CO $$ooai:digitalcollections.ohsu.edu:42915$$pstudent-work 000042915 980__ $$aTheses and Dissertations 000042915 981__ $$aPublished$$b2024-05-29