Mortality, Hospital Costs, Payments, and Readmissions Associated With Clostridium difficile Infection Among Medicare Beneficiaries

Drozd, Edward; Inocencio, Timothy J.; Braithwaite, S.F.; Jagun, Dayo; Shah, Hemal; Quon, Nicole; Broderick, Kelly C.; Kuti, Joseph L.

doi:10.1097/ipc.0000000000000299

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…Un hallazgo interesante en nuestro estudio fue la no asociación con mayor mortalidad, estancia hospitalaria ni estancia en la UCI entre casos y controles, a diferencia de lo reportado en otras series, donde la infección por C. difficile también se ha asociado a rehospitalizaciones 16 . Sin embargo, esta diferencia pudiera estribar en el número de los casos de esta serie, el uso de antibióticos activos contra C. difficile en forma temprana y el egreso de los pacientes en forma precoz para continuar manejo en casa.…”

Section: Discussionunclassified

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

2016

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Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia) ResumenObjetivos: Estimar la prevalencia y los factores relacionados con la infección por Clostridium difficile en un hospital de alta complejidad en Cali (Colombia). Métodos: Se realizó un estudio de casos y controles en pacientes que consultaron por diarrea o la desarrollaron durante la hospitalización y que tuvieron un resultado positivo en la prueba de PCR para Clostridium difficile. Durante el 2012 a 2014, se incluyeron 29 casos y 58 controles.Resultados: La prevalencia de Clostridium difficile hospitalaria en la institución fue de 10 por 10.000 pacientes hospitalizados; en 3 casos se identificó la cepa NAP1/ O27. Los factores relacionados a Clostridium difficile fueron la diabetes mellitus (OR = 7,4; IC 95%: 1,1-47,6; p = 0,035), la leucemia (OR: 4,1; IC 95%: 1,0-16,5; p = 0,043) y el consumo de antibióticos por más de 7 días (OR = 7,0; IC 95%: 2,3-21,1; p = 0,001). Conclusión: Se confirmó la asociación entre el uso previo de antibióticos y la infección por Clostridium difficile, de acuerdo con lo reportado en la literatura mundial. Este estudio describe por primera vez en nuestro país la cepa hipervirulenta NAP1/O27 en pacientes hospitalizados. Results:The prevalence of Clostridium difficile in the hospital was 10 per 10.000 hospitalised patients, in 3 cases the NAP1/O27 strain was identified. Factors associated with Clostridium difficile were diabetes mellitus (OR = 7.4, IC95%: 1.1-47.6, P=.035), leukaemia (OR: 4.1, IC95%: 1,0-16.5, P=.043) and consumption of antibiotics for more than 7 days (OR = 7.0, IC95%: 2,3-21.1, P=.001).Conclusions: This study confirmed the association of Clostridium difficile infection with the use of previous antibiotics, in accordance with that reported in literature. This study describes for the first time in our country the hypervirulent NAP1/O27 in hospitalised patients. Keywords: Clostridium difficile; Risk factors; Diarrhea; Genexpert IntroducciónClostridium difficile (C. difficile) se ha descrito recientemente como la primera causa de infecciones intrahospitalarias en hospitales de Estados Unidos 1 . El C. difficile es un bacilo grampositivo anaerobio estricto, formador de esporas. En su ciclo biológico, existen 2 estados: vegetativo, responsable de las manifestaciones clínicas y caracterizado por la capacidad de producir toxinas, que pueden ser eliminadas por algunos antibióticos (por ejemplo, metronidazol, vancomicina); y latente, en forma de esporas, las cuales no produce toxinas y resisten a las condiciones de temperatura, humedad y al efecto de los antibióticos 2,3 . La sintomatología de esta infección va desde la aparición de deposiciones diarreicas hasta el megacolon tóxico asociado a leucocitosis y a sepsis severa. Los cuadros clínicos de mayor severidad se encuentran especialmente relacionados con la inmunosupresión y el uso de antibióticos por un periodo superior a 5 días 2,4 .

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Section: Discussionunclassified

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

2016

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“…Drozd found 1.9% 30-day attributable mortality after hospital-onset CDI, although their analysis included younger beneficiaries (i.e., end-stage renal disease, disabled). 8 Shorr reported attributable CDI mortality of 14.9% at 60 days and 19.2% at one year in the elderly. 9 Prior studies estimating the risk of mortality due to CDI have not considered the possibility of effect modification, in which the risk is not uniform but varies depending on other factors.…”

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Clostridium difficile infection increases acute and chronic morbidity and mortality

Olsen

Stwalley

Demont

et al. 2018

Infect. Control Hosp. Epidemiol.

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Objective: The goal of this study was to quantify short- and long-term outcomes of Clostridium difficile infection (CDI) in the elderly, including all-cause mortality, transfer to a facility, and hospitalizations. Design: Retrospective study using 2011 Medicare claims data, including all elderly persons coded for CDI and a sample of uninfected persons. Analysis of propensity score-matched pairs and the entire population stratified by the propensity score was used to determine the risk of all-cause mortality, new transfer to a long-term care facility (LTCF) and short-term skilled nursing facility (SNF), and subsequent hospitalizations within 30, 90, and 365 days. Results: 174,903 persons coded for CDI were compared with 1,318,538 controls. CDI was associated with increased risk of death (OR 1.77, 95% CI: 1.74–1.81, attributable mortality 10.9%), new LTCF transfer (OR 1.74, 95% CI: 1.67–1.82) and new SNF transfer (OR 2.52, 95% CI: 2.46–2.58) within 30 days in matched pairs analyses. In stratified analysis CDI was associated with greatest risk of 30-day all-cause mortality in persons with lowest baseline probability of CDI (HR 3.04, 95% CI: 2.83–3.26); the risk progressively decreased as the baseline probability of CDI increased. CDI was also associated with increased risk of subsequent 30-day, 90-day, and one year hospitalization. Conclusions: CDI was associated with increased risk of short- and long-term adverse outcomes, including transfer to short- and long-term care facilities, hospitalization, and all-cause mortality. The magnitude of mortality risk varied depending on baseline probability of CDI, suggesting even lower-risk patients may benefit from interventions to prevent CDI.

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“…Symptomatic first recurrence after resolution of the primary CDI episode occurs in 20%–30% of patients, usually within 30 days after treatment cessation [3–5]. Clostridium difficile infection mortality estimates vary widely in the literature, with rates ranging from less than 5% to more than 20% in severe cases [6, 7]. A review of 27 studies found that the CDI-associated mortality rate was 6% within 3 months of diagnosis [8].…”

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Predictors of Mortality Among a National Cohort of Veterans With Recurrent Clostridium difficile Infection

Appaneal

Caffrey

Beganovic

et al. 2018

Open Forum Infectious Diseases

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BackgroundThough recurrent Clostridium difficile infection (CDI) is common and poses a major clinical concern, data are lacking regarding mortality among patients who survive their initial CDI and have subsequent recurrences. Risk factors for mortality in patients with recurrent CDI are largely unknown.MethodsVeterans Affairs patients with a first CDI (stool sample with positive C. difficile toxin(s) and ≥2 days CDI treatment) were included (2010–2014). Subsequent recurrences were defined as additional CDI episodes ≥14 days after the stool test date and within 30 days of the end of treatment. A matched (1:4) case–control analysis was conducted using multivariable conditional logistic regression to identify predictors of all-cause mortality within 30 days of the first recurrence.ResultsCrude 30-day all-cause mortality rates were 10.6% for the initial CDI episode, 8.3% for the first recurrence, 4.2% for the second recurrence, and 5.9% for the third recurrence. Among 110 cases and 440 controls, 6 predictors of mortality were identified: use of proton pump inhibitors (PPIs; odds ratio [OR], 3.86; 95% confidence interval [CI], 2.14–6.96), any antibiotic (OR, 3.33; 95% CI, 1.79–6.17), respiratory failure (OR, 8.26; 95% CI, 1.71–39.92), congitive dysfunction (OR, 2.41; 95% CI, 1.02–5.72), nutrition deficiency (OR, 2.91; 95% CI, 1.37–6.21), and age (OR, 1.04; 95% CI, 1.01–1.07).ConclusionsIn our national cohort of Veterans, crude mortality decreased by 44% from the initial episode to the third recurrence. Treatment with antibiotics, use of PPIs, and underlying comorbidities were important predictors of mortality in recurrent CDI. Our study assists health care providers in identifying patients at high risk of death after CDI recurrence.

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Mortality, Hospital Costs, Payments, and Readmissions Associated With Clostridium difficile Infection Among Medicare Beneficiaries

Abstract: Supplemental digital content is available in the text.

Cited by 21 publications

References 23 publications

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

Prevalencia y factores relacionados con la infección por Clostridium difficile en un centro hospitalario de alta complejidad en Cali (Colombia)

Clostridium difficile infection increases acute and chronic morbidity and mortality

Predictors of Mortality Among a National Cohort of Veterans With Recurrent Clostridium difficile Infection

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