MedStar Authors catalog › Details for: Clostridium difficile recurrence is a strong predictor of 30-day rehospitalization among patients in intensive care.
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Clostridium difficile recurrence is a strong predictor of 30-day rehospitalization among patients in intensive care.

by Shorr, Andrew F.
Citation: Infection Control & Hospital Epidemiology. 36(3):273-9, 2015 Mar..Journal: Infection control and hospital epidemiology.ISSN: 1559-6834.Full author list: Zilberberg MD; Shorr AF; Micek ST; Kollef MH.UI/PMID: 25695168.Subject(s): Adult | Aged | Clostridium difficile/ip [Isolation & Purification] | *Clostridium difficile | *Critical Care | Critical Illness | Cross Infection/di [Diagnosis] | Cross Infection/th [Therapy] | *Cross Infection | Enterocolitis, Pseudomembranous/di [Diagnosis] | Enterocolitis, Pseudomembranous/th [Therapy] | *Enterocolitis, Pseudomembranous | Female | Humans | Logistic Models | Male | Middle Aged | *Patient Readmission/sn [Statistics & Numerical Data] | Recurrence | Retrospective Studies | Risk FactorsInstitution(s): MedStar Washington Hospital CenterDepartment(s): Medicine/Pulmonary-Critical CareActivity type: Journal Article.Medline article type(s): Journal Article | Multicenter Study | Research Support, Non-U.S. Gov'tDigital Object Identifier: http://dx.doi.org/10.1017/ice.2014.47 (Click here) Abbreviated citation: Infect Control Hosp Epidemiol. 36(3):273-9, 2015 Mar.Local Holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006.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.Abstract: 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.Abstract: 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).Abstract: 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.

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