345. Nation-wide Survey Outcomes in Adults with Clostridium difficile Infection for 2005-2009
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: Clostridium difficile infection (CDI) is a leading cause of nosocomial infection with an increasing incidence and severity noted over the past decade.  A recent analysis of the National Hospital Discharge Survey (NHDS) data showed an increasing incidence of CDI in hospitalized children for 1997-2006. We therefore analyzed NHDS data from 2005-2009 to evaluate outcomes in adult patients with CDI. 

Methods: NHDS collects information on patients dismissed from non-Federal short-stay United States hospitals with a mean length of stay (LOS) < 30 days & is available in the public domain at http://www.cdc.gov/nchs/nhds.htm. Data collected includes demographics, diagnosis, procedures, LOS, dismissal & reimbursement information. Univariate & multivariate analyses were performed for demographics & clinical outcomes using SAS ver 9.1 & JMP ver 9.

Results: There were 1,185,477 adult patients in the 5-year study period with a median age of 58 years & 60.9% were females.  There were 9,911 CDI cases with an overall rate of 83.6/10,000 hospitalizations. Patients with CDI were significantly older than patients without CDI (median age 75 years versus 58 years, p<0.0001); & female sex was less likely associated with CDI (OR 0.95, 95%CI 0.95-0.99; p=0.03).  On univariate analysis, patients with CDI had a longer mean LOS (10.6 days versus 4.8 days, p<0.0001), higher rates of total-colectomy (OR 12.3, 95%CI 8.9-16.9, p<0.0001)  higher all-cause mortality (7.6% versus 2.3%, p<0.0001), & more likely to be dismissed to a care facility (45.7% versus 14.8%, p<0.0001).  On adjusting for age, patients with CDI had longer LOS (p<0.0001), all-cause mortality (OR 2.29, 95%CI 2.12-2.47), total-colectomy (OR 11.3, 95%CI 8.1-15.4) & dismissal to a care facility (OR 3.01, 95%CI 2.87-3.16). 

Conclusion: Despite advancements and interest in infection control & management, CDI remains a major problem in hospitalized patients, & is complicated by increased LOS, mortality & likelihood for dismissal to a short- or long-term care facility. Several actions are needed & include more aggressive policies in infection control and antimicrobial stewardship & education to enhance the early recognition & prompt treatment of CDI to hopefully prevent adverse outcomes & reduce spread of infection.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Sahil Khanna, MBBS1, Larry M. Baddour, MD2 and Darrell Pardi, MD, MS1, (1)Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, (2)Mayo School of Graduate Medical Education, Rochester, MN

Disclosures:

S. Khanna, None

L. M. Baddour, None

D. Pardi, None

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