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Clostridium difficile Recurrence Is a Strong Predictor of 30-Day Rehospitalization Among Patients in Intensive Care

Published online by Cambridge University Press:  22 December 2014

Marya D. Zilberberg ,
Andrew F. Shorr ,
Scott T. Micek  and
Marin H. Kollef
Marya D. Zilberberg*
Affiliation:
EviMed Research Group, LLC, Goshen, MA School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
Andrew F. Shorr
Affiliation:
Washington Hospital Center, Washington, DC
Scott T. Micek
Affiliation:
St. Louis College of Pharmacy, St. Louis, MO
Marin H. Kollef
Affiliation:
Barnes-Jewish Hospital, St. Louis, MO.
*
Address correspondence to Marya Zilberberg, MD, MPH, EviMed Research Group, LLC, PO Box 303, Goshen, MA 01032 (evimedgroup@gmail.com).
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Abstract

Objective

While incidence, mortality, morbidity, and recurrence rates of C. difficile infection (CDI) among the critically ill have been investigated, the impact of its recurrence on 30-day rehospitalization (ReAd), an important policy focus, has not been examined.

Design

Secondary analysis of a multicenter retrospective cohort study

Patients

Adult critically ill patients who survived their index hospitalization complicated by CDI

Methods

CDI was defined by diarrhea or pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. CDI recurrence (rCDI) was defined as diarrhea, positive C. difficile toxin and need for retreatment after cessation of therapy. Descriptive statistics and a logistic regression examined ReAd rates and characteristics, and factors that impact it.

Results

Among 287 hospital survivors, 76 (26.5%) required ReAd (ReAd+). At baseline, the ReAd+ group did not differ significantly from the ReAd– group based on demographics, comorbidities, APACHE II scores, or ICU type. ReAd+ patients were more likely to have hypotension at CDI onset (48.7% vs 34.1%, P=.025) and to require vasopressors (40.0% vs 27.1%, P=.038); they were less likely to require mechanical ventilation (56.0% vs 77.3%, P<.001). A far greater proportion of ReAd+ than ReAd– had developed a recurrence either during the index hospitalization or within 30 days after discharge (32.89% vs 2.84%, P<.001). In a logistic regression, rCDI was a strong predictor of ReAd+ (adjusted odd ratio, 15.33, 95% confidence interval, 5.68–41.40).

Conclusions

Greater than 25% of all survivors of critical illness complicated by CDI require readmission within 30 days of discharge. CDI recurrence is a strong predictor of such rehospitalizations.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 273 - 279
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presentation: These data have been accepted for presentation at the annual ID Week 2014 in Philadelphia, PA.

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