Low Incidence Of Clostridium Difficile Infection (CDI) in Patients Treated with Community Outpatient Parenteral Antimicrobial Therapy (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
K. K. Wong,
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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