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Frequent Hospital Readmissions for Clostridium difficile Infection and the Impact on Estimates of Hospital-Associated C. difficile Burden
  • Published Date:
    Nov 11 2011
  • Source:
    Infect Control Hosp Epidemiol. 33(1):20-28.
Filetype[PDF-1.73 MB]

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  • Description:

    Clostridium difficile infection (CDI) is associated with medical care and may cause readmission following hospitalization for any reason. The incidence of readmissions due to CDI is not well known.


    Retrospective cohort study of adult inpatients in one county from 2000–2007, using mandatory hospital discharge data.


    All hospitals in Orange County, California


    All adult inpatients readmitted with new-onset Clostridium difficile infection within 12 weeks of discharge.


    We assessed trends in hospital-associated CDI (HA-CDI) incidence, with and without inclusion of post-discharge CDI (PD-CDI) events resulting in re-hospitalization 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.


    From 2000 to 2007, countywide hospital-onset CDI (HO-CDI) incidence increased from 15/10,000 to 22/10,000 admissions. When including PD-CDI events, HA-CDI incidence doubled (29/10,000 in 2000 and 52/10,000 in 2007). Overall, including PD-CDI events resulted in significantly higher hospital-specific CDI incidence, although hospitals had disproportionate amounts of HA-CDI occurring post-discharge. 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.


    PD-CDI incidence may be underestimated since outpatient events were not evaluated. Inaccuracies in claims data may cause under or over-estimation of CDI cases. Whether C. difficile was acquired in the hospital or community post-discharge for PD-CDI is not known.


    PD-CDI events associated with re-hospitalization are increasingly common. The majority of HA-CDI cases now may be occurring post-discharge, 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.

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