Program Schedule

1635
A Retrospective Study Comparing Outcomes of Present on Admission Clostridium difficile Infection (CDI) versus Non-present on Admission CDI at a Tertiary-care Hospital in Detroit

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:

The aim of this study was to compare hospital-onset (Non-POA) CDI discharges to community-onset (POA) CDI discharges in order to assess the healthcare burden of hospital acquired CDI.

Methods:

A retrospective chart review of patients diagnosed with CDI was conducted at a tertiary-care hospital in Detroit between Jan 2011 and Dec 2012.  CDI Patients were classified as present-on-admission (POA) if they were primarily admitted with CDI or tested positive for CDI 48 hours prior and/or 48 hours after admission. Non-present-on-admission (Non-POA) patients were defined as being tested positive for CDI 48 hours after admission. Collected data included demographics, admission source, comorbidities, and length-of-stay (LOS). Thirty-day readmissions due to all causes including recurrent CDI as well as 30-day mortality rates were calculated and compared between POA and Non-POA CDI discharges.

Results:

The cohort included 710 patients with POA CDI and 602 patients with Non-POA CDI.  Although the mean age of POA group was not significantly different from the mean age of Non-POA group (61±19 vs 61±18, p=.95), Non-POA patients were more likely to be admitted with a rapidly fatal condition compared to POA patients (49 % vs 42%, p=.022).  On the other hand, POA patients were more likely to be admitted from home compared to Non-POA patients (76% vs 70%, p= .015).  The median LOS for Non-POA patients was significantly higher than that for POA patients (16 days, interquartile range {IQR} [10 – 27] vs 5 days, IQR [3 – 10], p<.001).  Although not statistically significant, 30-day readmissions due to CDI recurrence in the POA group were higher than that in the Non-POA group (5% vs 3%, p=.09).  The median time to readmission for POA patients was significantly higher than that for Non-POA patients (53 days, IQR [17 – 199] vs 34 days, IQR [11 – 137], p=.003).  Thirty-day mortality rate of Non-POA CDI patients was higher than that of POA CDI patients (11.5 % vs 6%, p<.001).

Conclusion:

Given the high morbidity and mortality rates among patients with hospital-onset CDI (Non-POA), efforts should focus on prevention strategies including regular surveillance, antimicrobial stewardship and quality improvement programs.

Reda A. Awali, MD, MPH, Iqbaljit Singh, MD, Sandhya Narukonda, MD, Sruthi Gaddipati, MD, Bharat Marwaha, MD, Keith Kaye, MD, MPH and Teena Chopra, MD, MPH, Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI

Disclosures:

R. A. Awali, None

I. Singh, None

S. Narukonda, None

S. Gaddipati, None

B. Marwaha, None

K. Kaye, Cubist Pharmaceuticals: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Grant recipient and Speaker honorarium

T. Chopra, None

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