Program Schedule

Low Incidence Of Clostridium Difficile Infection (CDI) in Patients Treated with  Community Outpatient Parenteral Antimicrobial Therapy (CoPAT)

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Hospital stay and antimicrobial therapy are the major risk factors for developing Clostridium difficileinfection (CDI). Community outpatient parenteral antimicrobial therapy (CoPAT) allows patients to reside in the community while being treated with parenteral antimicrobials. The purpose of this study was to evaluate the incidence and clinical outcomes of community onset CDI (CO-CDI) in patients treated with CoPAT.

Methods: All patients ≥ 18 years, discharged home with CoPAT from January- December 2013 were retrospectively reviewed. Patient who developed symptomatic diarrhea with positive stool toxin PCR assay within 4 weeks of CoPAT initiation in the community were identified as CO-CDI. A review of the electronic medical records was done to identify known CDI related risk factors, severity, treatment, recurrence, readmission and attributable mortality.

Results: During the study period, 2401 patients were discharged on CoPAT with 680 patients through the Cleveland Clinic Home Care agency. Five patients (0.74%) developed CO-CDI with an estimated incidence of 5 cases per 1000 CoPAT courses. The mean age of CO-CDI patients was 61.2 (SD±16) years and 4/5 patients (80%) were men. In patients with CO-CDI, the most frequently administered antimicrobials (2/5) were pipercillin/tazobactam and amikacin with a median duration of 12 days (IQR: 6.5-28). Four of 5 patients completed CoPAT prior to developing CO-CDI. The median duration from CoPAT completion to developing CDI was 9.5 days (IQR: 3-13). All five patients had a recent exposure to a healthcare facility excluding follow-up office visits. The median duration from exposure to development of CO-CDI was 8 days (IQR: 2-11.5). Of the 5 patients, 2 had hospital re-admissions and 3 had outpatient procedures. Four of 5 (80%) patients were on concomitant acid suppressive therapy. All patients had mild-moderate CDI and responded to medical therapy. Two patients had a hospital readmission but none were CDI related. There was no history of CDI recurrence or attributable mortality.

Conclusion: Patients receiving CoPAT had a low incidence of CO-CDI with no major complications. Most patients who developed CO-CDI had a recent healthcare exposure and were on concomitant acid suppressive therapy

Ken Koon Wong, MD1, Thomas G. Fraser, MD, FSHEA1, Nabin Shrestha, MD, MPH, FIDSA1 and Abhishek Deshpande, M.D., Ph.D.2, (1)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, (2)Infectious Diseases, Cleveland Clinic, Cleveland, OH


K. K. Wong, None

T. G. Fraser, None

N. Shrestha, Forest: Speaker's Bureau, Speaker honorarium
Merck: Speaker's Bureau, Speaker honorarium
The Medicines Company: Scientific Advisor, Consulting fee

A. Deshpande, None

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