Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T09:23:31.416Z Has data issue: false hasContentIssue false
  • English
  • Français

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 (gabriel.escobar@kp.org).
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.

References

REFERENCES

1. Vardakas, KZ, Polyzos, KA, Patouni, K, Rafailidis, PI, Samonis, G, Falagas, ME. Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int J Antimicrob Agents 2012;40:1–8.Google Scholar
2. Garey, KW, Sethi, S, Yadav, Y, DuPont, HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. Journal Hosp Infect 2008;70:298–304.Google Scholar
3. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403–410.Google Scholar
4. McFarland, LV, Surawicz, CM, Rubin, M, Fekety, R, Elmer, GW, Greenberg, RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hospl Epidemiol 1999;20:43–50.Google Scholar
5. Kelly, CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 2012;18:21–27.CrossRefGoogle ScholarPubMed
6. Shields, K, Araujo-Castillo, RV, Theethira, TG, Alonso, CD, Kelly, CP. Recurrent Clostridium difficile infection: from colonization to cure. Anaerobe 2015;34:59–73.Google Scholar
7. Youngster, I, Russell, GH, Pindar, C, Ziv-Baran, T, Sauk, J, Hohmann, EL. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA 2014:7.Google Scholar
8. Lowy, I, Molrine, DC, Leav, BA, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010;362:197–205.Google Scholar
9. Bagdasarian, N, Rao, K, Malani, PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 2015;313:10.Google Scholar
10. Selby, JV. Linking automated databases for research in managed care settings. Ann Intern Med 1997;127:719–724.CrossRefGoogle ScholarPubMed
11. Escobar, G, Greene, J, Scheirer, P, Gardner, M, Draper, D, Kipnis, P. Risk adjusting hospital inpatient mortality using automated inpatient, outpatient, and laboratory databases. Med Care 2008;46:232–239.Google Scholar
12. Liu, V, Kipnis, P, Gould, MK, Escobar, GJ. Length of stay predictions: improvements through the use of automated laboratory and comorbidity variables. Med Care 2010;48:739–744.CrossRefGoogle ScholarPubMed
13. Escobar, GJ, Greene, JD, Gardner, MN, Marelich, GP, Quick, B, Kipnis, P. Intra-hospital transfers to a higher level of care: contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS). J Hosp Med 2011;6:74–80.Google Scholar
14. Liu, V, Kipnis, P, Rizk, NW, Escobar, GJ. Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. J Hosp Med 2012;7:224–230.CrossRefGoogle Scholar
15. 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
16. Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.Google Scholar
17. Ellis, RP, Ash, A. Refinements to the diagnostic cost group (DCG) model. Inquiry 1995;32:418–429.Google Scholar
18. Ash, AS, Ellis, RP, Pope, GC, et al. Using diagnoses to describe populations and predict costs. HCF Review 2000;21:7–28.Google Scholar
19. Diagnostic Cost Groups. Models and methodologies guide. http://www.verisk.com. Published 2002. Accessed November 16, 2006.Google Scholar
20. Diagnostic Cost Groups. http://www.verisk.com. Published 2006. Accessed November 17, 2006.Google Scholar
21. van Walraven, C, Escobar, GJ, Greene, JD, Forster, AJ. The Kaiser Permanente inpatient risk adjustment methodology was valid in an external patient population. J Clin Epidemiol 2010;63:798–803.Google Scholar
22. Rosenbaum, PR. Observational Studies. 2nd ed. New York: Springer-Verlag; 2002.Google Scholar
23. Kosanke, J, Bergstralh, EJ. vmatch: Match cases to controls using variable optimal matching. Replaces OPTIMAL matching option from %MATCH macro. In: Mayo Clinic Division of Biomedical Statistics and Informatics, ed: Mayo Clinic; 2004.Google Scholar
24. Ziegler, A. Generalized Estimating Equations. Vol. 204. New York: Springer Science & Business Media; 2011.Google Scholar
25. Zou, G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702–706.Google Scholar
26. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.Google Scholar
27. Kuntz, JL, Johnson, ES, Raebel, MA, et al. Epidemiology and healthcare costs of incident Clostridium difficile infections identified in the outpatient healthcare setting. Infect Control Hospl Epidemiol 2012;33:1031–1038.Google Scholar
28. Ghantoji, SS, Sail, K, Lairson, DR, DuPont, HL, Garey, KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 2010;74:309–318.Google Scholar
29. Gabriel, L, Beriot-Mathiot, A. Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review. J Hosp Infect 2014;88:12–21.Google Scholar
30. Shah, DN, Aitken, SL, Barragan, LF, et al. Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study. J Hosp Infect 2016;93:286–289.CrossRefGoogle ScholarPubMed
31. Aitken, SL, Joseph, TB, Shah, DN, et al. Healthcare resource utilization for recurrent Clostridium difficile infection in a large university hospital in Houston, Texas. PLOS ONE 2014;9:e102848.Google Scholar
32. Olsen, MA, Yan, Y, Reske, KA, Zilberberg, MD, Dubberke, ER. Recurrent Clostridium difficile infection is associated with increased mortality. Clin Microbiol Infect 2015;21:164–170.CrossRefGoogle ScholarPubMed
33. Olsen, MA, Yan, Y, Reske, KA, Zilberberg, M, Dubberke, ER. Impact of Clostridium difficile recurrence on hospital readmissions. Am J Infect Control 2015;43:318–322.CrossRefGoogle ScholarPubMed
34. Barbut, F, Richard, A, Hamadi, K, Chomette, V, Burghoffer, B, Petit, JC. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol 2000;38:2386–2388.CrossRefGoogle ScholarPubMed
35. McFarland, LV, Elmer, GW, Surawicz, CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769–1775.Google Scholar
Supplementary material: File

Kuntz supplementary material

Appendix

Download Kuntz supplementary material(File)
File 382.4 KB