OBJECTIVE: To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis. BACKGROUND: Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay. MEASUREMENTS: We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups. MAIN RESULTS: Of 218,915 sepsis patients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDI patients than controls (25% vs 10%, P < 0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P < 0.001). CONCLUSIONS: After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed.
OBJECTIVE: To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis. BACKGROUND: Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay. MEASUREMENTS: We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups. MAIN RESULTS: Of 218,915 sepsispatients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDIpatients than controls (25% vs 10%, P < 0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P < 0.001). CONCLUSIONS: After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed.
Authors: Michael B Rothberg; Penelope S Pekow; Maureen Lahti; Oren Brody; Daniel J Skiest; Peter K Lindenauer Journal: J Hosp Med Date: 2010 May-Jun Impact factor: 2.960
Authors: Scott T Micek; Garrett Schramm; Lee Morrow; Erin Frazee; Heather Personett; Joshua A Doherty; Nicholas Hampton; Alex Hoban; Angela Lieu; Matthew McKenzie; Erik R Dubberke; Marin H Kollef Journal: Crit Care Med Date: 2013-08 Impact factor: 7.598
Authors: Erik R Dubberke; Anne M Butler; Kimberly A Reske; Denis Agniel; Margaret A Olsen; Gina D'Angelo; L Clifford McDonald; Victoria J Fraser Journal: Emerg Infect Dis Date: 2008-07 Impact factor: 6.883
Authors: David M Faleck; Hojjat Salmasian; E Yoko Furuya; Elaine L Larson; Julian A Abrams; Daniel E Freedberg Journal: Am J Gastroenterol Date: 2016-08-30 Impact factor: 10.864