Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting

Talan, David A.; Krishnadasan, Anusha; Citron, Diane M.; Paulick, Ashley; Anderson, Lydia; Goldstein, Ellie J. C.; Moran, Gregory J.; Abrahamian, Fredrick M.; Moore, J. H.; Femling, Jon; Chiang, William K.; LoVecchio, Frank; Jui, Jon; Garg, Mandeep; Steele, Mark T.; Sullivan, DE; Rothman, Richard E.

doi:10.1016/j.annemergmed.2016.12.013

Cited by 17 publications

(8 citation statements)

References 34 publications

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“…6 In addition, another study found C. difficile to be the causal pathogen in 10% of U.S. ED visits for diarrhea with no vomiting. 22 These studies offer additional support for our hypothesis of the ED as a setting for potential C. difficile exposure for vulnerable patients.…”

Section: Discussionsupporting

confidence: 52%

“…A recent study examining the prevalence of CDI in U.S. EDs identified 909,236 visits to the ED between 2006 and 2014 occurred as a result of CDI 6 . In addition, another study found C. difficile to be the causal pathogen in 10% of U.S. ED visits for diarrhea with no vomiting 22 . These studies offer additional support for our hypothesis of the ED as a setting for potential C. difficile exposure for vulnerable patients.…”

Section: Discussionmentioning

confidence: 74%

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Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Durant

Guerrazzi-Young

2021

J Patient Saf

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ObjectiveClostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals.MethodsA random-effects regression analysis compared each facility’s annual average ED wait time for admitted patients with that facility’s average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age.ResultsEmergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI.ConclusionsThe relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 74%

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Durant

Guerrazzi-Young

2021

J Patient Saf

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“…Patients with CDI had higher rates of hospitalization and intensive care unit admission than those without CDI. With the recent availability of rapid and accurate polymerase chain reaction (PCR) stool testing, this study supports consideration of CDI among ED patients presenting with diarrhea, particularly among those with greater illness severity, and including those without traditional risk factors [17]. …”

Section: Clinical Epidemiologic Researchmentioning

confidence: 66%

EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network

Santibañez

Fischer

Krishnadasan

et al. 2017

Open Forum Infectious Diseases

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As providers of frontline clinical care for patients with acute and potentially life-threatening infections, emergency departments (EDs) have the priorities of saving lives and providing care quickly and efficiently. Although these facilities see a diversity of patients 24 hours per day and can collect prospective data in real time, their ability to conduct timely research on infectious syndromes is not well recognized. EMERGEncy ID NET is a national network that demonstrates that EDs can also collect data and conduct research in real time. This network collaborates with the Centers for Disease Control and Prevention (CDC) and other partners to study and address a wide range of infectious diseases and clinical syndromes. In this paper, we review selected highlights of EMERGEncy ID NET’s history from 1995 to 2017. We focus on the establishment of this multisite research network and the network’s collaborative research on a wide range of ED clinical topics.

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“…The probability of CDI was based on a nationwide cohort of patients with diarrhea aged 65 years and older in the US. 17 There are limited robust data on age-specific mortality due to CDI. We derived CDI-attributable mortality for the initial episode in patients aged 65 and over from nationwide prospective surveillance 19 and the mortality rates for recurrences from a national cohort of veterans with recurrent disease.…”

Section: Probabilitiesmentioning

confidence: 99%

Cost-Effectiveness Analysis of Four Common Diagnostic Methods for Clostridioides difficile Infection

Xuan

Zangwill

et al. 2020

J GEN INTERN MED

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BACKGROUND: No studies have evaluated the costeffectiveness of single and two-step different diagnostic test strategies for Clostridioides difficile infection (CDI), including direct and indirect costs. OBJECTIVE: To evaluate the cost-effectiveness of commonly available diagnostic tests for CDI including nucleic acid amplification testing (NAAT) alone, glutamate dehydrogenase followed by enzyme immunoassay for toxin (GDH/EIA), GDH then NAAT (GDH/NAAT), and NAAT then EIA (NAAT/EIA). DESIGN: Decision tree model from the US societal perspective with inputs derived from the literature. Willingness-to-pay threshold was set at $150,000 per quality-adjusted life year (QALY) gained. To assess the impact of uncertainty in model inputs on the findings, we performed one-way and probabilistic sensitivity analyses. PARTICIPANTS: We conducted the analysis to represent a population aged 65 years old with diarrhea who received a CDI diagnostic test. MAIN MEASURES: Incremental cost-effectiveness ratios (ICER) and incremental net monetary benefits (INMB).

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Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting

Cited by 17 publications

References 34 publications

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

EMERGEncy ID NET: Review of a 20-Year Multisite Emergency Department Emerging Infections Research Network

Cost-Effectiveness Analysis of Four Common Diagnostic Methods for Clostridioides difficile Infection

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