Program Schedule

C. difficile Recurrence is a Strong Predictor of 30-day Rehospitalization Among ICU Patients

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: C. difficile infection (CDI) is as a deadly and costly problem. As a healthcare-associated complication, CDI has been immune to clinical and policy efforts to reduce its impact. While its incidence, mortality, morbidity and recurrence rates among critically ill have been investigated, the impact of recurrence on 30-day readmission, another important policy focus, has not been reported. 

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.

Marya D. Zilberberg, MD, MPH, University of Massachusetts and Evimed Research Group, LLC, Goshen, MA, Andrew F. Shorr, MD, MPH, Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, Scott Micek, PharmD, Pharmacy, Barnes-Jewish Hospital, St. Louis, MO and Marin Kollef, MD, Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO


M. D. Zilberberg, Cubist: Consultant and Grant Investigator, Research support

A. F. Shorr, Cubist: Consultant and Investigator, Research support

S. Micek, Cubist: Investigator, Research support

M. Kollef, Cubist: Consultant and Investigator, Research support

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