Hospital <i>Clostridium difficile</i> Infection Rates and Prediction of Length of Stay in Patients Without <i>C. difficile</i> Infection

Polgreen, Linnea A.; Cavanaugh, Joseph E.; Polgreen, Philip M.

doi:10.1017/ice.2015.340

Cited by 13 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study also revealed that steroids use did not affect the LOS in patients with CDI. Campbell et al reported renal impairment, advanced age, and cancer were associated with significantly longer LOS among hospital-onset CDI patients [ 21 , 22 ]. Stevens et al studied the excess LOS attributable to CDI in acute care hospitalizations, and found that, CDI significantly contributes to the overall LOS.…”

Section: Discussionmentioning

confidence: 99%

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

et al. 2017

View full text Add to dashboard Cite

BackgroundThe purpose of this study was to compare the outcome of Clostridium difficile infection (CDI) in patients on systemic steroids for various indications to patients not on steroids in term of disease severity, and associated morbidity and mortality.MethodsWe retrospectively reviewed records of all patients with CDI at our hospital from January 2011 to December 2016. Patients were evaluated for baseline characteristics, comorbidities, medications, disease severity, disease-related length of stay (LOS) from the diagnosis of CDI to discharge, need for surgical intervention, and disease-related mortality. Based on systemic steroids use, patients who were using steroids for different indications constituted the study population, and those with no steroids use were clustered as a control group.ResultsOf the 258 patients included, males were 127 (49%). Severe and severe-complicated CDI developed in 21/63 (33.3%) and 1/63 (1.6%) of patients on steroids (average daily dose of 20 mg), and in 73/195 (37.4%) and 5/195 (2.6%) of patients with no steroids use (P = 0.56 and P = 0.66, respectively). Surgical intervention was not required in the steroids group and 5/195 (2.7%) of patients not on steroids underwent bowel surgeries (P = 0.38). Mean LOS (days) was 11.6 ± 1.5 in the steroids group and 10.4 ± 0.7 in the no-steroids group (P = 0.4). CDI-related mortality occurred in 9/63(14.3%) of patients on steroids, and in 15/195 (7.7%) of patients not on steroids (P = 0.12; odds ratio (OR): 2; 95% confidence interval (CI): 0.8 - 4.8).ConclusionThere was no significant difference in the severity of CDI, need for surgical interventions, disease-related LOS and mortality in systemic steroids users compared to patients not on steroids.

show abstract

Section: Discussionmentioning

confidence: 99%

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

et al. 2017

View full text Add to dashboard Cite

show abstract

“…For example, the risk of C. difficile colonization and infection increases with longer length of stay in the hospital and increased length of stay in non-CDI patients has been associated with higher rates of CDI, suggesting that the average patient length of stay could be an important marker for CDI risk that should be considered. 29,30 In summary, our evaluation of 8 tertiary-care referral hospitals revealed that the current NHSN CDI SIR quality metric does not adequately adjust for the known higher CDI risk in oncology and HCT patients, despite the fact that the NHSN acknowledges and adjusts for the higher CDI risk in dedicated oncologic hospitals. Given the high financial and reputational stakes facing hospitals with high HO-CDI SIRs, the NHSN should improve the risk adjustment for general hospitals with large ONC-HCT patient populations as soon as possible.…”

Section: Discussionmentioning

confidence: 90%

Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals

Polage

Quan

Madey

et al. 2020

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective:To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.Design:Retrospective cohort study.Setting:Eight tertiary-care referral general hospitals in California.Methods:We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.Results:For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).Conclusions:For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.

show abstract

“…[25][26][27][28] The cost estimation in this study was conservative in different aspects: we considered the full cost borne by national health insurance (except add-on costs for the most expensive treatments that are paid on top of DRGs), we did not integrate indirect costs linked with productivity losses or premature mortality or costs incurred outside of hospitals. Also, in Miller et al, 29 the length of stay of non-CDI patients was correlated with CDI incidence, which may indicate that CDI incidence is a proxy for hospital efficiency and/or quality. This finding would not have impacted our results because controls were not specifically selected in the same hospital.…”

Section: Discussionmentioning

confidence: 92%

Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective

Leblanc¹,

Blein²,

Andremont

et al. 2017

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

OBJECTIVE To describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspective DESIGN Burden of illness study SETTING All acute-care hospitals in France METHODS Data were extracted from the French national hospitalization database (PMSI) for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10 th revision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs. RESULTS Overall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262). CONCLUSION CDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs. Infect Control Hosp Epidemiol 2017;38:906-911.

show abstract

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection

Cited by 13 publications

References 36 publications

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

Lack of Association Between the Clinical Outcome of Clostridium difficile Infection and Current Steroids Use

Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals

Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective

Contact Info

Product

Resources

About