Attributable outcomes of endemic Clostridium difficile associated disease in nonsurgical patients

Data are limited on the attributable outcomes of Clostridium difficile-associated disease (CDAD), particularly in CDAD-endemic settings. We conducted a retrospective cohort study of nonsurgical inpatients admitted for >/=48 hours in 2003 (N = 18,050). The adjusted hazard ratios for readmission (h...

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Bibliographic Details
Published in:Emerging infectious diseases 2008-07, Vol.14 (7), p.1031-1038
Main Authors: DUBBERKE, E.R, BUTLER, A.M, RESKE, K.A, AGNIEL, D, OLSEN, M.A, D'ANGELO, G, MCDONALD, L.C, FRASER, V.J
Format: Article
Language:English
Subjects:
Aged
attributable mortality
Biological and medical sciences
Clostridium
Clostridium difficile
Clostridium infections
Clostridium Infections - epidemiology
Cohort Studies
Cross Infection - epidemiology
Cross Infection - microbiology
Diagnosis
Diarrhea - microbiology
Distribution
Endemic Diseases
Female
Gastrointestinal Diseases - epidemiology
Gastrointestinal Diseases - microbiology
Health aspects
healthcare epidemiology
hospital-associated infections
Hospitals, Teaching
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Medical sciences
Middle Aged
Miscellaneous
outcomes
Patient Readmission
Prevention
Proportional Hazards Models
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
Risk factors
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Summary:Data are limited on the attributable outcomes of Clostridium difficile-associated disease (CDAD), particularly in CDAD-endemic settings. We conducted a retrospective cohort study of nonsurgical inpatients admitted for >/=48 hours in 2003 (N = 18,050). The adjusted hazard ratios for readmission (hazard ratio 2.19, 95% confidence interval [CI] 1.87-2.55) and deaths within 180 days (hazard ratio 1.23, 95% CI 1.03-1.46) were significantly different among CDAD case-patients and noncase patients. In a propensity score matched-pairs analysis that used a nested subset of the cohort (N = 706), attributable length of stay attributable to CDAD was 2.8 days, attributable readmission at 180 days was 19.3%, and attributable death at 180 days was 5.7%. CDAD patients were significantly more likely than controls to be discharged to a long-term-care facility or outside hospital. Even in a nonoutbreak setting, CDAD had a statistically significant negative impact on patient illness and death, and the impact of CDAD persisted beyond hospital discharge.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid1407.070867