High 30-day readmission rates associated with Clostridiumdifficile infection

Verheyen, Elijah; Dalapathi, Vijay; Arora, Shilpkumar; Patel, Kalpesh; Mankal, Pavan; Kumar, Varun; Lung, Edward; Kotler, Donald P.; Grinspan, Ari

doi:10.1016/j.ajic.2019.01.007

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…Moreover, our finding that fluoroquinolone exposure prior to index CDI diagnosis was a risk factor for CDI-related readmission extends the established connection between fluoroquinolone use and CDI. Additionally, our finding that being discharged home was a risk factor for CDI-related readmission is consistent with previous studies [ 24 , 25 , 26 ]. Lastly, a greater number of Elixhauser-related comorbidities [ 23 , 25 ] and individual comorbidities such as renal failure [ 24 , 25 , 27 ] and inflammatory bowel disease [ 10 ] are risk factors for CDI-related readmission.…”

Section: Discussionsupporting

confidence: 93%

“…Additionally, our finding that being discharged home was a risk factor for CDI-related readmission is consistent with previous studies [ 24 , 25 , 26 ]. Lastly, a greater number of Elixhauser-related comorbidities [ 23 , 25 ] and individual comorbidities such as renal failure [ 24 , 25 , 27 ] and inflammatory bowel disease [ 10 ] are risk factors for CDI-related readmission. We found that a higher Elixhauser comorbidity score, as a marker for overall patient comorbidity burden, was a risk factor for CDI-related readmission.…”

Section: Discussionsupporting

confidence: 93%

“…For this study, we opted to use a weighted Elixhauser comorbidity score that quantified the overall patient comorbidity burden [ 13 ]. Thus, our finding that a higher Elixhauser comorbidity score is a risk factor for CDI-related readmission adds utility to the established connection between comorbidities and CDI by expanding on previous studies that evaluated either individual [ 24 ] or number of comorbidities [ 23 , 25 ] without quantifying the burden. Our method of quantifying the comorbidity burden avoids analyzing multiple individual comorbidities, which increases the risk of overfitting the regression model, and categorizing patients based on the number of Elixhauser comorbidities, which assumes that each Elixhauser comorbidity affects the outcome equally.…”

Section: Discussionmentioning

confidence: 78%

“…Our study offers a novel evaluation of potential CDI-related readmission risk factors not available in previous studies that evaluated the risk factors for CDI-related readmission following index stay for CDI [ 24 , 25 , 27 ]. For instance, our model accounts for the inpatient treatment regimen for CDI to assess whether the specific treatment regimen that a patient received is associated with readmission, the timing of C. difficile specimen collection to assess whether patients with community- and healthcare-associated CDI are differentially at risk for readmission, and high-risk antibiotic use prior to index CDI diagnosis to assess whether exposure to a high-risk antibiotic is associated with readmission.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Hospital Readmission for Clostridioides difficile Infection: A Statewide Retrospective Cohort Study

et al. 2022

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(1) Background: Clostridioides difficile infection (CDI) is associated with a high recurrence rate, and a significant proportion of patients with CDI are readmitted following discharge. We aimed to identify the risk factors for CDI-related readmission within 90 days following an index hospital stay for CDI. (2) Methods: We analyzed the electronic medical data of admitted patients in our health system over a two-year period. A multivariate logistic regression model, supplemented with bias-corrected and accelerated confidence intervals (BCa-CI), was implemented to assess the risk factors. (3) Results: A total of 1253 adult CDI index cases were included in the analysis. The readmission rate for CDI within 90 days of discharge was 11% (140/1253). The risk factors for CDI-related readmission were fluoroquinolone exposure within 90 days before the day of index CDI diagnosis (aOR: 1.58, 95% CI: 1.05–2.37), higher Elixhauser comorbidity score (aOR: 1.05, 95% CI: 1.02–1.07), and being discharged home (aOR: 1.64, 95% CI: 1.06–2.54). In contrast, a longer length of index stay (aOR: 0.97, 95% BCa-CI: 0.95–0.99) was associated with reduced odds of readmission for CDI. (4) Conclusion: More than 1 out of 10 patients were readmitted for CDI following an index hospital stay for CDI. Patients with recent previous fluoroquinolone exposure, greater overall comorbidity burden, and those discharged home are at higher risk of readmission for CDI.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Hospital Readmission for Clostridioides difficile Infection: A Statewide Retrospective Cohort Study

et al. 2022

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“…Patients with Clostridioides di cile infection (CDI), can suffer from health outcomes that range from mild-to-severe diarrhoea to mortality, as well as experience costly hospitalizations and readmissions. [1][2][3][4][5][6] In addition to physical impacts, CDI impairs patients' psychological, social, professional, and nancial lives. 7 8 CDI remains a global health threat.…”

Section: Introductionmentioning

confidence: 99%

Application of Consolidated Framework for Implementation Research to Improve Clostridioides difficile Infection Management in South African District Hospitals

Legenza

Coetzee

Rose

et al. 2021

Preprint

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Background Clostridioides difficile infection (CDI) is a global health threat. Measurable gaps exist in CDI quality of care and CDI knowledge in South Africa. This study describes the development of a CDI intervention informed by the local context within South African public district level hospitals, and analyzes the CDI intervention development, implementation process and adaptations to understand acceptance, uptake, successes, and failures of the CDI intervention. Methods A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to contextualize study findings, including a description of the implementation process and adaptations for each hospital. A mixed-methods approach was applied with quantitative outcomes data and qualitative interview and focus group data with front-line and administrative healthcare personnel. Transcripts were coded to a priori workflow steps as well as to aspects of the CDI checklist intervention and emerging themes. The CFIR framework was applied to results from the qualitative interviews, observations by research team members, and quantitative patient outcomes data in order to identify drivers and barriers to implementation and to understand differences in uptake at the three sites. Highly relevant and moderately relevant constructs for the Intervention, Inner Setting, and Implementation Process domains were identified. Results Each hospital adapted the implementation process based on available resources, while maintaining the intervention core elements. One hospital displayed high uptake of the intervention compared to the two other hospitals. Highly relevant CFIR constructs linked to intervention uptake included tension for change, strong peer intervention champions, champions in influential leadership positions, and intervention complexity, among others. Tension of change at the high uptake hospital was also supported by an academic partnership for antimicrobial stewardship. Conclusion We provide a straight-forward health systems strengthening intervention for CDI that is both needed and uncomplicated, in an understudied LMIC setting. Intervention uptake was highest in the hospital with tension for change, influential champions, and existing academic partnerships. Further research is needed in reaching and involving understudied settings with fewer academic connections and to examine impact on patient outcomes.

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Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study

Sharma

Weissman

Walradt

et al. 2021

Int J Colorectal Dis

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High 30-day readmission rates associated with Clostridiumdifficile infection

Cited by 7 publications

References 35 publications

Risk Factors for Hospital Readmission for Clostridioides difficile Infection: A Statewide Retrospective Cohort Study

Risk Factors for Hospital Readmission for Clostridioides difficile Infection: A Statewide Retrospective Cohort Study

Application of Consolidated Framework for Implementation Research to Improve Clostridioides difficile Infection Management in South African District Hospitals

Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study

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