Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

Collins, Courtney; Aytürk, Mehmet; Anderson, Frederick A.; Santry, Heena P.

doi:10.1007/s11605-014-2638-6

Cited by 12 publications

(20 citation statements)

References 29 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%

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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%

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

et al. 2022

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“…There is evidence that age is associated with the development of different adverse outcomes. 22,23 Our findings suggest that LTCF residents >80 years of age had higher 30-day all-cause mortality but fewer 30-day all-cause acute-care admissions compared to those aged ≤80 years. A breakdown by decade after age 65 years was used in a preliminary analysis, but the number in each age group <85 years was too small to show differences.…”

Section: Discussionmentioning

confidence: 69%

“…A US study that followed acute-care patients with CDI for any acute-care readmission found that patients aged 65-84 years had higher readmission rates than patients aged >85 years (10.1 vs 8.6 per 100 cases; P < .05). 22 A potential explanation for why older residents may be less likely to be admitted to acute care, despite the increased mortality observed in this population, may be different preferences for end-of-life care. Studies from Europe and Canada showed that among persons aged >65 years, with increasing age, fewer people died in a hospital and more died in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

The use of laboratory-identified event surveillance to classify adverse outcomes due toClostridioides difficileinfection in Canadian long-term care facilities

Shen

Ellison

Leal

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Adverse outcomes following Clostridioides difficile infection (CDI) are not often reported for long-term care facility (LTCF) residents. We focused on the adverse outcomes due to CDI identified in Alberta LTCFs. Methods: All positive Clostridioides difficile stool specimens identified by laboratory-identified (LabID) event surveillance in Alberta from 2011 to 2018, along with Alberta Continuing Care Information System, were used to define CDI in Alberta LTCFs. CDI cases were classified as long-term care onset, hospital onset, and community onset. Laboratory records were linked to provincial databases to analyze acute-care admissions and mortality within 30-day post CDI. Age, sex, case classification, episode, and operator type, were investigated using logistic regression. Results: Overall, 902 CDI cases were identified in 762 LTCF residents. Of all CDI events, 860 (95.3%) were long-term care onset, 38 (4.2%) were hospital onset, and 4 (0.4%) were community onset. The CDI rate was 2.0 of 100,000 resident days. In total, 157 residents (20.6%) had 30-day all-cause mortality, 126 CDI cases (14.0%) had 30-day all-cause acute-care admissions. The 30-day all-cause mortality rate was significantly higher in residents aged >80 versus ≤80 years (24.9 vs 12.3 per 100 residents; P < .05). Residents aged >80 years, with hospital-onset CDI, and those staying in private or voluntary LTCFs were more likely to have 30-day all-cause acute-care admissions. Conclusions: The prevalence of CDI adverse outcomes is in LTCFs was found to be high using LabID event surveillance. Annual review of CDI adverse outcomes using LabID event can minimize the burden of surveillance and standardize the process across all Alberta LTCFs.

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“…Similar to previous findings, a principal diagnosis of CDI (as compared to those hospitalized without a principal diagnosis of CDI or outpatients) was identified as a significant predictor of failure likely related to CDI severity. [9,27,28] Previous hospital or long-term care exposure was also a predictor of poor outcomes. The association between CDI and exposure to healthcare settings is well recognized.…”

Section: Discussionmentioning

confidence: 99%

What Is the Role for Metronidazole in the Treatment of Clostridium difficile Infection? Results From a National Cohort Study of Veterans With Initial Mild Disease

Appaneal

Caffrey

LaPlante

2018

Clinical Infectious Diseases

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Background Metronidazole may still be an appropriate therapeutic option for mild Clostridium difficile infection (CDI) in select patients, but data are limited to guide clinicians in identifying these patients. Methods Our 2-stage study included a national cohort of Veterans with a first episode of mild CDI (2010–2014). First, among those treated with metronidazole, we identified predictors of success, defined as absence of all-cause mortality or recurrence 30 days posttreatment, using multivariable unconditional logistic regression. Second, among a subgroup of patients with characteristics predictive of success identified in the first stage, we compared clinical outcomes among those treated with metronidazole compared with vancomycin, using Cox proportional hazards models for time to 30-day all-cause mortality, CDI recurrence, and failure. Results Among 3656 patients treated with metronidazole, we identified 3282 patients with success and 374 patients without success (failure). Younger age was the only independent predictor of success. Age ≤65 years was associated with an odds of success 1.63 times higher (95% confidence interval [CI], 1.29–2.06) than age >65 years. Among 115 propensity score–matched pairs ≤65 years of age, no significant differences were observed between metronidazole and vancomycin (reference) for all-cause mortality (hazard ratio [HR], 0.29 [95% CI, .06–1.38]), CDI recurrence (HR, 0.62 [95% CI, .26–1.49]), or failure (HR, 0.50 [95% CI, .23–1.07]). Conclusions Among patients ≤65 years of age with initial mild CDI, clinical outcomes were similar with metronidazole and vancomycin. These data suggest that metronidazole may be considered for the treatment of initial mild CDI among patients 65 years of age or younger.

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Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

Cited by 12 publications

References 29 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

The use of laboratory-identified event surveillance to classify adverse outcomes due toClostridioides difficileinfection in Canadian long-term care facilities

What Is the Role for Metronidazole in the Treatment of Clostridium difficile Infection? Results From a National Cohort Study of Veterans With Initial Mild Disease

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