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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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| Published in: | Emerging infectious diseases 2008-07, Vol.14 (7), p.1031-1038 |
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| container_end_page | 1038 |
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| container_title | Emerging infectious diseases |
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| creator | DUBBERKE, E.R BUTLER, A.M RESKE, K.A AGNIEL, D OLSEN, M.A D'ANGELO, G MCDONALD, L.C FRASER, V.J |
| description | 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. |
| doi_str_mv | 10.3201/eid1407.070867 |
| format | article |
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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.</description><identifier>ISSN: 1080-6040</identifier><identifier>EISSN: 1080-6059</identifier><identifier>DOI: 10.3201/eid1407.070867</identifier><identifier>PMID: 18598621</identifier><language>eng</language><publisher>United States: U.S. National Center for Infectious Diseases</publisher><subject>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. 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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.</description><subject>Aged</subject><subject>attributable mortality</subject><subject>Biological and medical sciences</subject><subject>Clostridium</subject><subject>Clostridium difficile</subject><subject>Clostridium infections</subject><subject>Clostridium Infections - epidemiology</subject><subject>Cohort Studies</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Diagnosis</subject><subject>Diarrhea - microbiology</subject><subject>Distribution</subject><subject>Endemic Diseases</subject><subject>Female</subject><subject>Gastrointestinal Diseases - epidemiology</subject><subject>Gastrointestinal Diseases - microbiology</subject><subject>Health aspects</subject><subject>healthcare epidemiology</subject><subject>hospital-associated infections</subject><subject>Hospitals, Teaching</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>outcomes</subject><subject>Patient Readmission</subject><subject>Prevention</subject><subject>Proportional Hazards Models</subject><subject>Public health. 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Hygiene-occupational medicine</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DUBBERKE, E.R</creatorcontrib><creatorcontrib>BUTLER, A.M</creatorcontrib><creatorcontrib>RESKE, K.A</creatorcontrib><creatorcontrib>AGNIEL, D</creatorcontrib><creatorcontrib>OLSEN, M.A</creatorcontrib><creatorcontrib>D'ANGELO, G</creatorcontrib><creatorcontrib>MCDONALD, L.C</creatorcontrib><creatorcontrib>FRASER, V.J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Science in Context</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Emerging infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DUBBERKE, E.R</au><au>BUTLER, A.M</au><au>RESKE, K.A</au><au>AGNIEL, D</au><au>OLSEN, M.A</au><au>D'ANGELO, G</au><au>MCDONALD, L.C</au><au>FRASER, V.J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Attributable outcomes of endemic Clostridium difficile associated disease in nonsurgical patients</atitle><jtitle>Emerging infectious diseases</jtitle><addtitle>Emerg Infect Dis</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>14</volume><issue>7</issue><spage>1031</spage><epage>1038</epage><pages>1031-1038</pages><issn>1080-6040</issn><eissn>1080-6059</eissn><abstract>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.</abstract><cop>United States</cop><pub>U.S. National Center for Infectious Diseases</pub><pmid>18598621</pmid><doi>10.3201/eid1407.070867</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Attributable outcomes of endemic Clostridium difficile associated disease in nonsurgical patients |
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