Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

Kimura, Tomomi; Stanhope, Stephen A.; Sugitani, Toshifumi

doi:10.1017/s0950268820000606

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…We found that patients with a history of CDI were more likely to develop CDIs after THA, and patients who had CDI no more than 6 months before arthroplasty were much more likely to experience this potentially life-threatening complication. Studies have reported all-cause CDI mortality as high as 33% [2, 10, 11, 16, 21, 26, 27, 30, 31]. Recurrent infection further adds to the risk of death [10, 17, 27].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a history of CDI before THA had longer hospital stays, but the difference probably was not clinically important; by contrast, the frequency with which these patients were readmitted to the hospital within 90 days of surgery was substantial, especially among those who had CDIs no more than 6 months before THA. These findings are likely multifactorial, as the health profile of patients with CDIs reported in other studies suggest a demographic with poorer overall health and reduced recovery capacity [2, 6, 9, 10, 11, 16-18, 24, 25, 29, 32, 34]. The greater risk of readmissions may also be due to treatment for repeat CDI, postoperative complications, or exacerbation of comorbid conditions because of CDI [2, 5, 6, 10, 11, 22, 23, 25, 26].…”

Section: Discussionmentioning

confidence: 99%

“…Eighty percent of deaths from CDI occur in adults older than 65 years, which also is the most common demographic for THA [6]. Furthermore, the healthcare consequences of CDIs include increased hospital lengths of stay, readmissions, and costs [2,11,16,17,24,32,33]. These sequelae negatively affect hospital quality metrics, but more importantly, put the patient at substantial risk for exacerbation of chronic medical conditions like inflammatory bowel disease, reinfection with CDI after surgery, and death [2,6,11,12,13,[23][24][25][26]35].…”

Section: Introductionmentioning

confidence: 99%

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THAs Performed Within 6 Months of Clostridioides difficile Infection Are Associated with Increased Risk of 90-Day Complications

Douglas

Remily

Sax

et al. 2021

Clin Orthop Relat Res

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Background Clostridioides difficile infection (CDI) may be a surrogate for poor patient health. As such, a history of CDI before THA may be used to identify patients at higher risk for postoperative CDI and complications after THA. Investigations into the associations between CDI before THA and postoperative CDI and complications are lacking. Questions/purposes We compared the (1) frequency and potential risk factors for CDI after THA, (2) the frequency of 90-day complications after THA in patients with and without a history of CDI, and (3) the length of stay and frequency of readmissions in patients experiencing CDIs more than 6 months before THA, patients experiencing CDIs in the 6 months before THA, and patients without a history of CDI. Methods Patients undergoing primary THA from 2010 to 2019 were identified in the PearlDiver database using ICD and Current Procedural Terminology codes (n = 714,185). This analysis included Medicare, Medicaid, and private insurance claims across the United States with the ability to perform longitudinal and costs analysis using large patient samples to improve generalizability and reduce error rates. Patients with a history of CDI before THA (n = 5196) were stratified into two groups: those with CDIs that occurred more than 6 months before THA (n = 4003, median 2.2 years [interquartile range 1.2 to 3.6]) and those experiencing CDIs within the 6 months before THA (n = 1193). These patients were compared with the remaining 708,989 patients without a history of CDI before THA. Multivariable logistic regression was used to evaluate the association of risk factors and incidence of 90-day postoperative CDI in patients with a history of CDI. Variables such as antibiotic use, proton pump inhibitor use, chemotherapy, and inflammatory bowel disease were included in the models. Chi-square and unadjusted odds ratios with 95% confidence intervals were used to compare complication frequencies. A Bonferroni correction adjusted the p value significance threshold to < 0.003. Results Prior CDI during either timespan was associated with higher unadjusted odds for postoperative CDI (CDI > 6 months before THA: OR 8.44 [95% CI 6.95 to 10.14]; p < 0.001; CDI ≤ 6 months before THA: OR 49.92 [95% CI 42.26 to 58.54]; p < 0.001). None of the risk factors included in the regression were associated with increased odds for postoperative CDI in patients with preoperative history of CDI. Patients with a history of CDI before THA were associated with higher unadjusted odds for every 90-day complication compared with patients without a history of CDI before THA. CDI during either timespan was associated with longer lengths of stay (no CDI before THA: 3.8 days; CDI > 6 months before THA: 4.5 days; CDI ≤ 6 months before THA: 5.3 days; p < 0.001) and 90-day readmissions (CDI > 6 months before THA: OR 2.21 [95% CI 1.98 to 2.47]; p < 0.001; CDI ≤ 6 months before THA: OR 3.39 [95% CI 2.85 to 4.02]; p < 0.001). Conclusion Having CDI before THA was associated with higher odds of postoperative CDI compared with patients without a history of CDI. A history of CDI within the 6 months before THA was associated with the greatest odds for postoperative complications and readmissions. Providers should strongly consider delaying THA until 6 months after CDI, if possible, to provide adequate time for patient recovery and eradication of infection. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

THAs Performed Within 6 Months of Clostridioides difficile Infection Are Associated with Increased Risk of 90-Day Complications

Douglas

Remily

Sax

et al. 2021

Clin Orthop Relat Res

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“…The probability of recurrent healthcare onset CDI was obtained from a study based on a hospital claims database in Japan, where the recurrence of CDI increased with each subsequent CDI [ 24 ]. Excess mortality from incident and recurrent CDI were modelled with the same rates, based on a matched cohort study using a hospital claims database in Japan [ 26 ]. Based on the published literature, we modelled mortality for false negative CDI as twice that of baseline CDI mortality [ 27 ], and mortality associated with treatment failure as 3.9 times that of baseline CDI mortality [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Budget Impact Analysis of Adopting a One-Step Nucleic Acid Amplification Testing (NAAT) Alone Diagnostic Pathway for Clostridioides difficile in Japan Compared to a Two-Step Algorithm with Glutamate Dehydrogenase/Toxin Followed by NAAT

Lim¹,

Tomaru²,

Chua

et al. 2023

Diagnostics

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Clostridioides difficile infection (CDI) is a major healthcare-associated infection that leads to a significant health economic burden in Japan. Using a decision tree model, we evaluated the budget impact of adopting a one-step nucleic acid amplification test (NAAT) alone pathway compared to a two-step diagnostic algorithm with glutamate dehydrogenase (GDH) and toxin antigen, followed by NAAT. The analysis was conducted from the government payer’s perspective for 100,000 symptomatic, hospitalized adults requiring a CDI diagnostic test. One-way sensitivity analysis was conducted for all data inputs. The NAAT alone strategy costed JPY 225,886,360 (USD 2,424,714) more, but was more effective, resulting in 1749 more patients accurately diagnosed and 91 fewer deaths compared to the two-step algorithm. Additionally, the NAAT alone pathway costed JPY 26,146 (USD 281) less per true positive CDI diagnosed. The total budget impact, and cost per CDI diagnosed was most sensitive to GDH sensitivity in one-way sensitivity analysis, where a lower GDH sensitivity resulted in greater cost savings with the NAAT alone pathway. Findings from this budget impact analysis can guide the adoption of a NAAT alone pathway for CDI diagnosis in Japan.

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ARTICLE INFO ABSTRACTClostridioides difficile is a gram-positive, spore-forming bacterium that produces toxins capable of causing severe infectious diarrhea and pseudomembranous colitis in humans.

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mentioning

confidence: 99%

"Allogenic Fecal Microbiota Transplantation in Clostridioides Difficile Infection: A Case Series in Mexico"

López‐Vidal¹,

Soto-Hernández

Orduña

et al. 2021

BJSTR

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BackgroundClostridioides difficile has become the major cause of health care-associated diarrhea and a recognized causal agent of pseudomembranous colitis [1,2]. It is a primary infection with major recurrence rate among hospitalized patients; spore renders Clostridioides difficile, highly transmissible and resistant to antimicrobial treatment [1,3,4]. Infection is characterized by toxin production leading to intestinal barrier line up areas of cell necrosis and an intense local and/or systemic inflammatory response ARTICLE INFO ABSTRACTClostridioides difficile is a gram-positive, spore-forming bacterium that produces toxins capable of causing severe infectious diarrhea and pseudomembranous colitis in humans. We reviewed eight cases of antimicrobial therapy-resistant C. difficile infection (CDI) in patients with various pathologies. The diagnosis was confirmed by toxin detection and colonoscopy. Stool for fecal microbiota transplantation (FMT) was prepared from healthy selected donors; all cases received the FMT through retention enema. In most of the patients, CDI symptoms decreased within the first 24h post-FMT. We carried out short-, medium-, and long-term follow-up post-FMT, which showed an 88% of efficacy. Observed efficacy is similar to the current 80-100% reported frequently, whereas the main difference with previous reports lays on the fact that half of our patients showed baseline affectations involving surgery, neurological conditions or immune system deficiency. This study provides examples for establishing solid criteria for the FMT among patients with recurrent CDI and baseline affectations. This is a small case series and results should be considered within limitations; however, it is relevant to add all experiences to build a better knowledge on this clinical tool.

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Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

Cited by 10 publications

References 37 publications

THAs Performed Within 6 Months of Clostridioides difficile Infection Are Associated with Increased Risk of 90-Day Complications

THAs Performed Within 6 Months of Clostridioides difficile Infection Are Associated with Increased Risk of 90-Day Complications

Budget Impact Analysis of Adopting a One-Step Nucleic Acid Amplification Testing (NAAT) Alone Diagnostic Pathway for Clostridioides difficile in Japan Compared to a Two-Step Algorithm with Glutamate Dehydrogenase/Toxin Followed by NAAT

"Allogenic Fecal Microbiota Transplantation in Clostridioides Difficile Infection: A Case Series in Mexico"

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