492. Long term Outcomes of Clostridium difficile Infection among Medicare Beneficiaries
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • KHatfield_CDI_EIPCMS_OPRE_9262018 Final.pdf (837.8 kB)
  • Background: Clostridium difficile infection (CDI) is a common healthcare-associated infection, particularly among older adults. We used laboratory-confirmed CDI surveillance data from 8 states participating in the Centers for Disease Control and Prevention’s Emerging Infections Program linked to claims data for Centers for Medicare & Medicaid Services (CMS) beneficiaries to measure variation in one-year outcomes associated with CDI.

    Methods: A CDI case was defined as a positive C. difficile stool test in 2014 in a person without a positive test in the prior 8 weeks. Cases aged ≥65 years were linked to their CMS beneficiary ID using unique combinations of date of birth, sex, and zip code. Each case was matched to five control beneficiaries who did not link to any case and were residents of the same catchment area. Inclusion criteria were continuous fee-for-service Medicare for the entire study period (one year before and after event date), and no hospitalization or skilled nursing facility stay with an ICD-9-CM code for CDI in the year prior to their match date. Multivariable logistic regression models were used to compare mortality and hospitalization for one year following the event date between beneficiaries with and without CDI, adjusting for age, sex, race, catchment area, chronic conditions, number of hospitalizations in the prior year, and hospitalization status at the time of and 7 days preceding the event date.

    Results: Of 5,097 cases aged ≥65, 3,082 (60%) were linked to a CMS ID, and 1,832 (59%) met inclusion criteria. In crude analysis, 34% of beneficiaries with CDI died within one year, compared to 5% of beneficiaries without CDI. Beneficiaries with CDI were also more likely to be hospitalized in the subsequent year (54% vs 17%). Beneficiaries with CDI had a higher adjusted odds of death (adjusted OR 3.01, 95% CI: 2.46, 3.69) and hospitalization within one year (adjusted OR 1.93, 95% CI: 1.65, 2.25) than those without CDI.

    Conclusion: Older adults with CDI were three times more likely to die in the year following infection and nearly two times more likely to be hospitalized compared to those without CDI, revealing independent long term risk of poor outcomes. This excess morbidity and mortality supports the need to develop novel CDI prevention strategies for this population.

    Kelly M. Hatfield, MSPH1, James Baggs, PhD1, Lisa G. Winston, MD2,3, Erin Parker, MPH3, Brittany Martin, MPH3, James I. Meek, MPH4, Danyel Olson, MS, MPH4, Monica M. Farley, MD, FIDSA5,6, Andrew Revis, MPH6, Stacy Holzbauer, DVM, MPH7,8, Maria Bye, MPH7, Lucy Wilson, MD, ScM9, Rebecca Perlmutter, MPH9, Erin C. Phipps, DVM, MPH10, Rebecca Pierce, PhD, MS, BSN11, Valerie L.S. Ocampo, RN, MIPH11, Marion A. Kainer, MBBS, MPH12, Miranda Smith, MPH12, L. Clifford McDonald, MD1, John A. Jernigan, MD, MS1 and Alice Guh, MD, MPH1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, (3)California Emerging Infections Program, Oakland, CA, (4)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (5)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (6)Georgia Emerging Infections Program, Atlanta, GA, (7)Minnesota Department of Health, Saint Paul, MN, (8)Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, (9)Maryland Department of Health, Baltimore, MD, (10)New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, (11)Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, OR, (12)Tennessee Department of Health, Nashville, TN

    Disclosures:

    K. M. Hatfield, None

    J. Baggs, None

    L. G. Winston, None

    E. Parker, None

    B. Martin, None

    J. I. Meek, None

    D. Olson, None

    M. M. Farley, None

    A. Revis, None

    S. Holzbauer, None

    M. Bye, None

    L. Wilson, None

    R. Perlmutter, None

    E. C. Phipps, None

    R. Pierce, None

    V. L. S. Ocampo, None

    M. A. Kainer, None

    M. Smith, None

    L. C. McDonald, None

    J. A. Jernigan, None

    A. Guh, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.