OBJECTIVE: Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD. RESEARCH DESIGN AND METHODS: A retrospective analysis (2005-2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group. RESULTS: A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4-4.6) additional days in older patients to 7.8 (95% CI = 5.7-9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001). LIMITATIONS: Missing cost data and potential misclassification of colonized patients as infected. CONCLUSIONS: Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.
OBJECTIVE: Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD. RESEARCH DESIGN AND METHODS: A retrospective analysis (2005-2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group. RESULTS: A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDADpatients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4-4.6) additional days in older patientsto 7.8 (95% CI = 5.7-9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001). LIMITATIONS: Missing cost data and potential misclassification of colonized patients as infected. CONCLUSIONS:Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDADpatients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.
Authors: Tara Lagu; Mihaela S Stefan; Sarah Haessler; Thomas L Higgins; Michael B Rothberg; Brian H Nathanson; Nicholas S Hannon; Jay S Steingrub; Peter K Lindenauer Journal: J Hosp Med Date: 2014-04-09 Impact factor: 2.960
Authors: C Rubio-Terrés; J Cobo Reinoso; S Grau Cerrato; J Mensa Pueyo; M Salavert Lletí; A Toledo; P Anguita; D Rubio-Rodríguez; M Watt; R Gani Journal: Eur J Clin Microbiol Infect Dis Date: 2015-09-25 Impact factor: 3.267
Authors: Nicole M Wood; Sierra Davis; Karen Lewing; Janelle Noel-MacDonnell; Earl F Glynn; Doina Caragea; Mark A Hoffman Journal: JCO Clin Cancer Inform Date: 2021-03
Authors: Massimo Sartelli; Mark A Malangoni; Fikri M Abu-Zidan; Ewen A Griffiths; Stefano Di Bella; Lynne V McFarland; Ian Eltringham; Vishal G Shelat; George C Velmahos; Ciarán P Kelly; Sahil Khanna; Zaid M Abdelsattar; Layan Alrahmani; Luca Ansaloni; Goran Augustin; Miklosh Bala; Frédéric Barbut; Offir Ben-Ishay; Aneel Bhangu; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Laura A Canterbury; Fausto Catena; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria Elena Cocuz; Raul Coimbra; Charles H Cook; Yunfeng Cui; Jacek Czepiel; Koray Das; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina Magdalena Dumitru; Catherine Eckert; Christian Eckmann; Edward H Eiland; Mushira Abdulaziz Enani; Mario Faro; Paula Ferrada; Joseph Derek Forrester; Gustavo P Fraga; Jean Louis Frossard; Rita Galeiras; Wagih Ghnnam; Carlos Augusto Gomes; Venkata Gorrepati; Mohamed Hassan Ahmed; Torsten Herzog; Felicia Humphrey; Jae Il Kim; Arda Isik; Rao Ivatury; Yeong Yeh Lee; Paul Juang; Luis Furuya-Kanamori; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Wen Chien Ko; Francis D LaBarbera; Jae Gil Lee; Ari Leppaniemi; Varut Lohsiriwat; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick Alan Moore; Carl Erik Nord; Carlos A Ordoñez; Gerson Alves Pereira Júnior; Nicola Petrosillo; Francisco Portela; Basant K Puri; Arnab Ray; Mansoor Raza; Miran Rems; Boris E Sakakushev; Gabriele Sganga; Patrizia Spigaglia; David B Stewart; Pierre Tattevin; Jean Francois Timsit; Kathleen B To; Cristian Tranà; Waldemar Uhl; Libor Urbánek; Harry van Goor; Angela Vassallo; Jean Ralph Zahar; Emanuele Caproli; Pierluigi Viale Journal: World J Emerg Surg Date: 2015-08-20 Impact factor: 5.469