<i>Clostridium difficile</i> Infection Among Veterans Health Administration Patients

Young‐Xu, Yinong; Kuntz, Jennifer L; Gerding, Dale N.; Neily, Julia; Mills, Peter D.; Dubberke, Erik R.; Olsen, Margaret A.; Kelly, Ciarán P.; Mahé, Cédric

doi:10.1017/ice.2015.138

Cited by 16 publications

(18 citation statements)

References 25 publications

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“…Interestingly, approximately three-quarters of the outpatient CDI episodes in the LabRx data were not supported by a positive test result, with 38 % identified on the basis of a CDI diagnosis alone. The percentage of outpatient CDI diagnoses without confirmation by a positive C. difficile laboratory test was very similar in our previous study using Veterans Administration data, in which only 32 % of the total outpatient CDI cases had a C. difficile test result [ 26 ]. Further studies to validate the use of the ICD-9-CM diagnosis code for CDI in the outpatient setting in the absence of positive C. difficile test results are warranted to determine the accuracy of coding outside of the hospital.…”

Section: Discussionsupporting

confidence: 70%

The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases

et al. 2016

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BackgroundMany administrative data sources are available to study the epidemiology of infectious diseases, including Clostridium difficile infection (CDI), but few publications have compared CDI event rates across databases using similar methodology. We used comparable methods with multiple administrative databases to compare the incidence of CDI in older and younger persons in the United States.MethodsWe performed a retrospective study using three longitudinal data sources (Medicare, OptumInsight LabRx, and Healthcare Cost and Utilization Project State Inpatient Database (SID)), and two hospital encounter-level data sources (Nationwide Inpatient Sample (NIS) and Premier Perspective database) to identify CDI in adults aged 18 and older with calculation of CDI incidence rates/100,000 person-years of observation (pyo) and CDI categorization (onset and association).ResultsThe incidence of CDI ranged from 66/100,000 in persons under 65 years (LabRx), 383/100,000 in elderly persons (SID), and 677/100,000 in elderly persons (Medicare). Ninety percent of CDI episodes in the LabRx population were characterized as community-onset compared to 41 % in the Medicare population. The majority of CDI episodes in the Medicare and LabRx databases were identified based on only a CDI diagnosis, whereas almost ¾ of encounters coded for CDI in the Premier hospital data were confirmed with a positive test result plus treatment with metronidazole or oral vancomycin. Using only the Medicare inpatient data to calculate encounter-level CDI events resulted in 553 CDI events/100,000 persons, virtually the same as the encounter proportion calculated using the NIS (544/100,000 persons).ConclusionsWe found that the incidence of CDI was 35 % higher in the Medicare data and fewer episodes were attributed to hospital acquisition when all medical claims were used to identify CDI, compared to only inpatient data lacking information on diagnosis and treatment in the outpatient setting. The incidence of CDI was 10-fold lower and the proportion of community-onset CDI was much higher in the privately insured younger LabRx population compared to the elderly Medicare population. The methods we developed to identify incident CDI can be used by other investigators to study the incidence of other infectious diseases and adverse events using large generalizable administrative datasets.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1501-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 70%

The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases

et al. 2016

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“…CDI incidence seems to have also increased dramatically among veterans compared to the general population. A prior study by Young-Xu et al [ 14 ] reported an increase of 19% in CDI episodes from 2009 to 2013 with a stabilization of rates from 2011 to 2013 in the VHA population. Our results are in-line with this prior study; however, differences in incidence rates can be attributed to the longitudinal nature of our study, in which we were able to separate initial episodes from recurrences.…”

Section: Discussionmentioning

confidence: 99%

National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014

et al. 2017

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IntroductionPrior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period.MethodsThis was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally.ResultsOverall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days).ConclusionsInitial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes.

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“…For example, the estimated incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in 2011 across the US was 25 per 100,000 persons, or at least 8 times more common than CRE [ 26 ]. In the Veterans Health Administration during 2009–2013, the overall incidence of C. difficile was approximately 200 infections per 100,000 patient-years, which was at least 65 times more common than CRE [ 27 ]. It is important to note that, even though the current incidence of CRE is low, CRE has been rapidly spreading across the US.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States

Livorsi

Chorazy

Schweizer

et al. 2018

Antimicrob Resist Infect Control

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BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) pose an urgent public health threat in the United States. An important step in planning and monitoring a national response to CRE is understanding its epidemiology and associated outcomes. We conducted a systematic literature review of studies that investigated incidence and outcomes of CRE infection in the US.MethodsWe performed searches in MEDLINE via Ovid, CDSR, DARE, CENTRAL, NHS EED, Scopus, and Web of Science for articles published from 1/1/2000 to 2/1/2016 about the incidence and outcomes of CRE at US sites.ResultsFive studies evaluated incidence, but many used differing definitions for cases. Across the entire US population, the reported incidence of CRE was 0.3–2.93 infections per 100,000 person-years. Infection rates were highest in long-term acute-care (LTAC) hospitals. There was insufficient data to assess trends in infection rates over time. Four studies evaluated outcomes. Mortality was higher in CRE patients in some but not all studies.ConclusionWhile the incidence of CRE infections in the United States remains low on a national level, the incidence is highest in LTACs. Studies assessing outcomes in CRE-infected patients are limited in number, small in size, and have reached conflicting results. Future research should measure a variety of clinical outcomes and adequately adjust for confounders to better assess the full burden of CRE.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0346-9) contains supplementary material, which is available to authorized users.

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Clostridium difficile Infection Among Veterans Health Administration Patients

Cited by 16 publications

References 25 publications

The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases

The burden of clostridium difficile infection: estimates of the incidence of CDI from U.S. Administrative databases

National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014

A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States

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