C. difficile Recurrence is a Strong Predictor of 30-day Rehospitalization Among ICU Patients
Methods: We conducted a secondary analysis of a multi-center retrospective cohort study of critically ill patients who survived their index hospitalization complicated by CDI. CDI was defined by the presence of diarrhea or pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. Recurrence of CDI (rCDI) was defined as diarrhea and positive C. difficile toxin after cessation of therapy and need for retreatment. We used descriptive statistics and a logistic regression to examine the rates and characteristics of 30-day readmission and the factors that impact it, with a specific attention to rCDI.
Results: Among 287 hospital survivors, 76 (26.5%) required a readmission within 30 days after discharge. At baseline, the group requiring a readmission did not differ significantly from the group that did not based on demographics, comorbidities, APACHE II scores or ICU type. Those with a readmission, however, were more likely to have hypotension at CDI onset (48.7% vs. 34.1%, p=0.025) and require vasopressors (40.0% vs. 27.1%, p=0.038), had a lower median BMI (24.7 vs. 27.8, p<0.001), and were less likely to require mechanical ventilation (56.0% vs. 77.3%, p<0.001). A far greater proportion of those requiring a readmission than those who did not had developed a recurrence either during the index hospitalization or within 30 days after discharge (28.95% vs. 2.84%, p<0.001). In a logistic regression, rCDI was a strong predictor of the need for 30-day rehospitalization (OR 15.33, 95% CI 5.68-41.40).
Over ¼ of all survivors of critical illness complicated by CDI require readmission within 30 days of discharge. CDI recurrence is a strong driver of such readmissions.
M. D. Zilberberg,
Cubist: Consultant and Grant Investigator, Research support
S. Micek, Cubist: Investigator, Research support
M. Kollef, Cubist: Consultant and Investigator, Research support
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