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Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study

Published online by Cambridge University Press:  20 October 2016

Jennifer L. Kuntz ,
Jennifer M. Baker ,
Patricia Kipnis ,
Sherian Xu Li ,
Vincent Liu ,
Yang Xie ,
Stephen Marcella  and
Gabriel J. Escobar
Jennifer L. Kuntz
Affiliation:
Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
Jennifer M. Baker
Affiliation:
Kaiser Permanente Northern California Division of Research, Oakland, California
Patricia Kipnis
Affiliation:
Kaiser Permanente Northern California Division of Research, Oakland, California
Sherian Xu Li
Affiliation:
Kaiser Permanente Northern California Division of Research, Oakland, California
Vincent Liu
Affiliation:
Kaiser Permanente Northern California Division of Research, Oakland, California
Yang Xie
Affiliation:
Center for Observational and Real-World Evidence, Merck, Lebanon, New Jersey
Stephen Marcella
Affiliation:
Center for Observational and Real-World Evidence, Merck, Lebanon, New Jersey
Gabriel J. Escobar*
Affiliation:
Kaiser Permanente Northern California Division of Research, Oakland, California
*
Address correspondence to Gabriel J. Escobar, MD, Kaiser Permanente Division of Research, 2000 Broadway Ave, 032 R01, Oakland, CA 94612 ([email protected]).
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Abstract

BACKGROUND

Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited.

OBJECTIVE

To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI.

METHODS

We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity.

RESULTS

We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI.

CONCLUSIONS

Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI.

Infect Control Hosp Epidemiol. 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 45 - 52
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: The European Congress of Clinical Microbiology and Infectious Diseases; Barcelona, Spain; May 10–13, 2014; and the Interscience Conference on Antimicrobial Agents and Chemotherapy; Washington, DC; September 5–9, 2014.

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