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Frequent Hospital Readmissions for Clostridium difficile Infection and the Impact on Estimates of Hospital-Associated C. difficile Burden

Published online by Cambridge University Press:  02 January 2015

Courtney R. Murphy ,
Taliser R. Avery ,
Erik R. Dubberke  and
Susan S. Huang
Courtney R. Murphy*
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Taliser R. Avery
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Erik R. Dubberke
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
*
Health Policy Research Institute, 100 Theory Drive, Suite 110, Irvine, CA 92617 ([email protected])
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Abstract

Objective.

Clostridium difficile infection (CDI) is associated with hospitalization and may cause readmission following admission for any reason. We aimed to measure the incidence of readmissions due to CDI.

Design.

Retrospective cohort study.

Patients.

Adult inpatients in Orange County, California, who presented with new-onset CDI within 12 weeks of discharge.

Methods.

We assessed mandatory 2000–2007 hospital discharge data for trends in hospital-associated CDI (HA-CDI) incidence, with and without inclusion of postdischarge CDI (PD-CDI) events resulting in rehospitalization within 12 weeks of discharge. We measured the effect of including PD-CDI events on hospital-specific CDI incidence, a mandatory reporting measure in California, and on relative hospital ranks by CDI incidence.

Results.

From 2000 to 2007, countywide hospital-onset CDI (HO-CDI) incidence increased from 15 per 10,000 to 22 per 10,000 admissions. When including PD-CDI events, HA-CDI incidence doubled (29 per 10,000 in 2000 and 52 per 10,000 in 2007). Overall, including PD-CDI events resulted in significantly higher hospital-specific CDI incidence, although hospitals had disproportionate amounts of HA-CDI occurring postdischarge. This resulted in substantial shifts in some hospitals' rankings by CDI incidence. In multivariate models, both HO and PD-CDI were associated with increasing age, higher length of stay, and select comorbidities. Race and Hispanic ethnicity were predictive of PD-CDI but not HO-CDI.

Conclusions.

PD-CDI events associated with rehospitalization are increasingly common. The majority of HA-CDI cases may be occurring postdischarge, raising important questions about both accurate reporting and effective prevention strategies. Some risk factors for PD-CDI may be different than those for HO-CDI, allowing additional identification of high-risk groups before discharge.

Infect Control Hosp Epidemiol 2012;33(1):20-28

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 1 , January 2012 , pp. 20 - 28
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. Meltzer, DO, Chung, JW. U.S. trends in hospitalization and generalist physician workforce and the emergence of hospitalists. J Gen Intern Med 2010;25:453–459.CrossRefGoogle ScholarPubMed
2. Yokoe, DS, Avery, TR, Huang, SS. Surgical Site Infection Surveillance following Total Hip and Knee Arthroplasty Using California Administrative Data. Oral presentation, Society for Healthcare Epidemiology of America; April 1–4, 2011; Dallas, TX.Google Scholar
3. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
4. Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.CrossRefGoogle ScholarPubMed
5. Huang, SS, Piatt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
6. Weinberger, M, Oddone, EZ, Henderson, WG. Does increased access to primary care reduce hospital readmissions? N Engl J Med 1996;334:1441–1447.CrossRefGoogle ScholarPubMed
7. Jweinat, JJ. Hospital readmission under the spotlight. J Healthc Manag 2010;55:252–264.Google ScholarPubMed
8. Centers for Medicare and Medicaid Services/Joint Commission. http://www.jointcommission.org/home_care_-_reducing_hospital_readmissions_bibliography/. Accessed November 11, 2011.Google Scholar
9. Cohen, AL, Calfee, D, Fridkin, SK, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC Position Paper. Infect Control Hosp Epidemiol 2008;29:901–913.CrossRefGoogle ScholarPubMed
10. National Health Safety Network, Centers for Disease Control and Prevention. Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. http://www.cdc.gov/nhsn/mdro_cdad.html. Accessed July 5, 2011.Google Scholar
11. Healthcare-Associated Infection Working Group of the Joint Public Policy Committee (SHEA/APIC/CSTE/CDC). Essentials of Public Reporting of Healthcare-Associated Infections: A Tool Kit. http://www.shea-online.org/Assets/files/Essentials_of_Public_Reporting_Tool_Kit.pdf. Accessed July 5, 2011.Google Scholar
12. Association for Professionals in Infection Control and Epidemiology. Healthcare-Associated Infection Legislation in Progress 2010. http://www.apic.org/downloads/legislation/HAI_map.gif. Accessed July 5, 2011.Google Scholar
13. Dubberke, ER, Gerding, DN, Classen, D, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S81–S92.CrossRefGoogle ScholarPubMed
14. Huang, SS, Avery, TR, Song, Y, et al. Quantifying inter-hospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:1160–1169.CrossRefGoogle Scholar
15. Dubberke, ER, Butler, AM, Reske, KA, et al. Attributable outcomes of endemic Clostridium difficile-associated disease in non-surgical patients. Emerg Infect Dis 2008;14:1031–1038.CrossRefGoogle Scholar
16. Issa, M, Ananthakrishnan, AN, Binion, DG. Clostridium difficile and inflammatory bowel disease. Inflamm Bowel Dis 2008;14:1432–1442.CrossRefGoogle ScholarPubMed
17. Chang, HT, Krezolek, D, Johnson, S, Parada, JP, Evans, CT, Gerding, DN. Onset of symptoms and time to diagnosis of Clostridium difficile-associated disease following discharge from an acute care hospital. Infect Control Hosp Epidemiol 2007;28:926–931.CrossRefGoogle ScholarPubMed
18. Dubberke, ER, McMullen, KM, Mayfield, JL, et al. Hospital-associated Clostridium difficile infection: is it necessary to track community-onset disease? Infect Control Hosp Epidemiol 2009;30:332–337.CrossRefGoogle ScholarPubMed
19. Kutty, PK, Benoit, SR, Woods, CW, et al. Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008;29:197–202.CrossRefGoogle ScholarPubMed
20. Palmore, TN, Sohn, S, Malak, SF, Eagan, J, Sepkowitz, KA. Risk factors for acquisition of Clostridium difficile-associated diarrhea among outpatients at a cancer hospital. Infect Control Hosp Epidemiol 2005;26:680–684.CrossRefGoogle Scholar
21. Kelly, CP, Pothoulakis, C, Lamont, JT. Clostridium difficile colitis. N Engl J Med 1994;330:257–262.CrossRefGoogle ScholarPubMed
22. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
23. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
24. Elixhauser, A, Jhung, M. Clostridium difficile-Associated Disease in U.S. Hospitals, 1993–2005. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, 2008. Statistical Brief 50.Google Scholar
25. Campbell, RJ, Giljahn, L, Machesky, K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infection Control Hosp Epidemiol 2009;30:526–533.CrossRefGoogle ScholarPubMed
26. Hookman, P, Barkin, JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol 2009;15:1554–1580.CrossRefGoogle ScholarPubMed
27. Warny, M, Pepin, J, Fang, A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.CrossRefGoogle Scholar
28. Miller, M, Gravel, D, Mulvey, M, et al. Healthcare-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis 2010;50:194–201.CrossRefGoogle Scholar
29. McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
30. Miller, BA, Chen, LF, Sexton, DJ, Anderson, DJ. The Impact of Hospital-Onset Healthcare Facility Associated (HO-HCFA) Clostridium difficile Infection (CDI) In Community Hospitals: Surpassing Methicillin-Resistant Staphylococcus aureus (MRSA) As the New Superbug. Oral presentation, top four abstracts at the Fifth Decennial International Conference on Healthcare-Associated Infections. March 2010, Atlanta, GA.Google Scholar
31. Association for Professionals in Infection Control and Epidemiology. Clostridium difficile Legislation in Progress 2010. http://www.cqstatetrack.com/texis/viewrpt/+yeOlOjemuAB?report=4cab75bbeb1. Accessed July 5, 2011.Google Scholar
32. Committee to Reduce Infection Deaths. State Legislation and Initiatives on Healthcare-Associated Infections. Updated March 2010. http://www.hospitalinfection.org/legislation.shtml. Accessed July 5, 2011.Google Scholar
33. Office of Statewide Health Planning and Development. http://www.oshpd.ca.gov/. Accessed July 5, 2011.Google Scholar
34. Leibson, CL, Needleman, J, Buerhaus, P, et al. Identifying in-hospital venous thromboembolism (VTE): a comparison of claims-based approaches with the Rochester Epidemiology Project VTE cohort. Med Care 2008;46:127–132.CrossRefGoogle ScholarPubMed
35. Musher, DM, Aslam, S, Logan, N. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.CrossRefGoogle ScholarPubMed
36. Nelson, A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc 2002;94:666–668.Google ScholarPubMed
37. Williams, DR. Racial variations in adult health status: patterns, paradoxes and prospects. In: Smelser, N, Wilson, WJ, Mitchell, F, eds. America Becoming: Racial Trends and Their Consequences. Vol 2. Washington, DC: National Academy of Sciences, 2001:371–410.Google Scholar
38. Courtenay, W. Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Soc Sci Med 2000;50:1385–1401.CrossRefGoogle ScholarPubMed
39. Lee, C, Owens, RG. Issues for a psychology of men's health. J Health Psychol 2002;7:209–217.CrossRefGoogle ScholarPubMed
40. Schmiedeskamp, M, Harpe, S, Polk, R, Oinonen, M, Pakyz, A. Use of international classification of diseases, ninth revision: clinical modification codes and medication use data to identify nosocomial Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:1070–1076.CrossRefGoogle ScholarPubMed
41. Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9-CM codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.CrossRefGoogle ScholarPubMed
42. Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262–268.CrossRefGoogle ScholarPubMed
43. Goldman, LE, Chu, PW, Prothro, C, Osmond, D, Bindman, AB. Accuracy of condition present on admission, do not resuscitate, and E-codes in California patient discharge data. Prepared for the Office of Statewide Health Planning and Development, spring 2011.Google Scholar