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Onset of Symptoms and Time to Diagnosis of Clostridium difficile–Associated Disease Following Discharge From an Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

Heidi T. Chang ,
Dorota Krezolek ,
Stuart Johnson ,
Jorge P. Parada ,
Charlesnika T. Evans  and
Dale N. Gerding
Heidi T. Chang
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Dorota Krezolek
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Stuart Johnson
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Jorge P. Parada
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Charlesnika T. Evans
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
Dale N. Gerding*
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
*
Research Service (151), Hines VA Hospital, Fifth Avenue and Roosevelt Road, Bldg 1, Rm C344, Hines, IL 60141 ([email protected])
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Abstract

Objective.

To identify patients with a diagnosis of Clostridium difficile–associated disease (CDAD) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials.

Design.

Single-center, retrospective study.

Methods.

Medical records were reviewed for outpatients and hospitalized patients with a stool assay positive for C. difficile toxin A from January 1998 through March 2005. Patients with recurrent CDAD or residing in an extended-care facility were excluded. CDAD in patients who had been hospitalized in the 100 days prior to diagnosis was considered potentially hospital-associated.

Results.

Of the 84 patients who met the inclusion criteria, 75 (89%) received a diagnosis 1-60 days after hospital discharge (median, 12 days), and 71 (85%) received a diagnosis within 30 days after discharge. Of the 69 patients whose records contained information regarding time of symptom onset, 62 (90%) developed diarrhea within 30 days of a previous hospital discharge, including 7 patients with symptom onset prior to discharge and 9 with onset on the day of discharge. The median time from symptom onset to diagnosis was 6 days. Of 84 patients, 77 (92%) had received antimicrobials during a prior hospitalization, but 55 (65%) received antimicrobials both as inpatients and as outpatients.

Conclusion.

If all cases of CDAD diagnosed within 100 days of hospital discharge were assumed to be hospital-associated, 71 (85%) of 84 patients with CDAD were identified within 30 days, and 75 (89%) of 84 were identified by day 60. Continued outpatient antimicrobial exposure confounds determination of whether late-onset cases are community- or hospital-associated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 926 - 931
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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