Methods: Among adult patients with incident CDI at KP Northwest, we identified those with an rCDI between 07/01/05 and 12/31/14. Recurrent CDI was defined as a CDI diagnosis 15-56 days after incident CDI. We used the first rCDI for all data collection and analyses. We classified cases by the setting where they were identified, either inpatient or outpatient. We collected demographic and clinical information before and on the rCDI diagnosis date and identified healthcare utilization, additional rCDIs, and surgical intervention in the 180 days and mortality in the 1 year following rCDI.
Results: We identified 1,126 rCDIs; 77% in the outpatient setting. Patients with rCDI were, on average, 67 years old and 63% were female. Patients often had at least one outpatient visit (91%), emergency department (ED) visit (45%), or hospitalization (35%) for any reason in the 180 days after rCDI. One-third of patients had a CDI-related outpatient visit within 180 days, while 13% and 10% had a CDI-related hospitalization or ED visit, respectively. Patients with inpatient-identified rCDI were more likely to require hospitalization or an ED visit for CDI or any reason than patients with outpatient-identified rCDI. One-year all-cause mortality was 21.2%. Mortality was higher among those with inpatient-identified rCDI (39%) than among those with outpatient-identified rCDI (16%). Twelve percent of patients experienced at least one additional rCDI; 68% of these patients (103 of 152) had one additional recurrence. Less than 1% of patients underwent a colectomy procedure after rCDI.
Conclusion: Patients with inpatient-identified rCDI had more healthcare utilization and higher mortality than those with outpatient-identified rCDI, likely due to differences in underlying illness and healthcare exposures. Our study shows the ongoing burden of rCDI on patients and healthcare systems, regardless of where rCDI is identified, and suggests the need for improved rCDI management to minimize this burden.
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