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Epidemiology and Healthcare Costs of Incident Clostridium difficile Infections Identified in the Outpatient Healthcare Setting

Published online by Cambridge University Press:  02 January 2015

Jennifer L. Kuntz ,
Eric S. Johnson ,
Marsha A. Raebel ,
Amanda F. Petrik ,
Xiuhai Yang ,
Micah L. Thorp ,
Steven J. Spindel ,
Nancy Neil  and
David H. Smith
Jennifer L. Kuntz*
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
Eric S. Johnson
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
Marsha A. Raebel
Affiliation:
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado University of Colorado School of Pharmacy, Denver, Colorado
Amanda F. Petrik
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
Xiuhai Yang
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
Micah L. Thorp
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
Steven J. Spindel
Affiliation:
Department of Infectious Diseases, Kaiser Permanente Northwest, Portland, Oregon
Nancy Neil
Affiliation:
Decision Research, Eugene, Oregon University of Washington, Seattle, Washington
David H. Smith
Affiliation:
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
*
Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227 ([email protected])
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Abstract

Objective.

To describe the epidemiology and healthcare costs of Clostridium difficile infection (CDI) identified in the outpatient setting.

Design.

Population-based, retrospective cohort study.

Patients.

Kaiser Permanente Colorado and Kaiser Permanente Northwest members between June 1, 2005, and September 30, 2008.

Methods.

We identified persons with incident CDI and classified CDI by whether it was identified in the outpatient or inpatient healthcare setting. We collected information about baseline variables and follow-up healthcare utilization, costs, and outcomes among patients with CDI. We compared characteristics of patients with CDI identified in the outpatient versus inpatient setting.

Results.

We identified 3,067 incident CDIs; 56% were identified in the outpatient setting. Few strong, independent predictors of diagnostic setting were identified, although a previous stay in a nonacute healthcare institution (odds ratio [OR], 1.45 [95% confidence interval (CI), 1.13-1.86]) was statistically associated with outpatient-identified CDI, as was age from 50 to 59 years (OR, 1.64 [95% CI, 1.18-2.29]), 60 to 69 years (OR, 1.37 [95% CI, 1.03-1.82]), and 70 to 79 years (OR, 1.36 [95% CI, 1.06-1.74]), when compared with persons aged 80-89 years.

Conclusions.

We found that more than one-half of incident CDIs in this population were identified in the outpatient setting. Patients with outpatient-identified CDI were younger with fewer comorbidities, although they frequently had previous exposure to healthcare. These data suggest that practitioners should be aware of CDI and obtain appropriate diagnostic testing on outpatients with CDI symptoms.

Infect Control Hosp Epidemiol 2012;33(10):1031-1038

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 10 , October 2012 , pp. 1031 - 1038
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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