1400. Evaluation of Hospital Readmissions Following Clostridium Difficile Infection (CDI) and Patient Characteristics  Associated with CDI Recurrence during Hospital Readmission
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Clostridium difficile infection (CDI) has a high recurrence rate, but there is limited data on how recurrent CDI (rCDI) contributes to hospital readmission. This study aimed to evaluate how rCDI contributes to hospital readmission, and to identify patient characteristics associated with rCDI at 90-day readmission.

Methods: This was a retrospective case-control study at a 900-bed tertiary care community teaching hospital. All adult inpatients testing positive for CDI by PCR between May 2010 - Oct 2012 were included (index admission); those with CDI within the prior 90 days were excluded.  Hospital readmission was defined as re-hospitalization for any cause within 90 days of discharge after index admission. Cases were defined as readmissions experiencing rCDI at any point during readmission. Controls were defined as readmissions that did not experience rCDI. Retrospective chart review identified patient characteristics from index admission, including: age, Charlson comorbidity score, concomitant non-CDI antibiotic use following CDI diagnosis, discharge to skilled nursing facility, peak WBC ≥ 15,000 during admission, PPI/H2-blocker use, and bowel surgery.

Results: 1,504 patients were identified with CDI during index admission and survived to discharge. 30-day readmission occurred in 253 patients (16.8%), with rCDI identified in 33 (2.2%). 90-day readmission occurred in 616 patients (41.0%), with rCDI identified in 197 (13.1%). For patients readmitted within 90 days, rCDI was significantly associated with age ≥ 65 years (OR 1.6, 95%CI: 1.1-2.4), Charlson comorbidity score ≥ 6 (OR 5.2, 95%CI: 3.4-8.1), and non-CDI antibiotic use following index CDI diagnosis (OR 3.1, 95%CI: 2.1-4.6).

Conclusion: For adults hospitalized with CDI, 41% were readmitted within 90 days, and 13% developed rCDI during readmission. In those readmitted within 90 days, the highest risk of rCDI was associated with age ≥ 65 years, multiple co-morbidities (Charlson comorbidity score ≥ 6), and concomitant use of non-CDI antibiotics during index admission. Prospective studies are needed to identify patients at highest risk for hospital readmission with rCDI who might benefit from interventions to reduce CDI recurrence.

Edgar Wayne, MD1, Jonathan Grein, MD2 and Rehka Murthy, MD2, (1)Infectious Diseases, Cedars-Sinai Medical Center/GLA-VA/Olive View UCLA, Multicampus Fellowship in Infectious Diseases, Los Angeles, CA, (2)Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA

Disclosures:

E. Wayne, None

J. Grein, None

R. Murthy, None

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