OBJECTIVE:Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD. RESEARCH DESIGN AND METHODS:A retrospective analysis (2005-2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group. RESULTS:A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4-4.6) additional days in older patients to 7.8 (95% CI = 5.7-9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001). LIMITATIONS:Missing cost data and potential misclassification of colonized patients as infected. CONCLUSIONS:Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.

译文

目的:一般而言,医院发作的艰难梭菌相关性腹泻(HO-CDAD)与住院时间(LOS)延长和住院费用增加有关。 HO-CDAD的负担在可能具有不良预后的特别风险中的患者中未知:老年患者,患有复杂或慢性疾病的患者(肾脏疾病,癌症,炎性肠病[IBD])和伴有抗生素的患者(CAbx) )在CDAD治疗期间使用。
研究设计与方法:对HealthFacts®数据库(Cerner Corp.,堪萨斯城,密苏里州)进行的回顾性分析(2005-2011),其中包含来自美国186所医院的全面临床记录,根据正C值确定了住院的HO-CDAD成年患者入院后> 48 h收集到的艰难梭菌毒素。对照患者的总住院LOS≥2天。为每个研究组开发了单独的逻辑回归模型以估计倾向,以HO-CDAD vs对照作为结果。计算每组病例与对照之间的LOS和成本差异。
结果:共鉴定出4521例HO-CDAD患者。平均年龄为70岁,女性占54%,死亡13%。匹配后,除IBD外,其他各组的HO-CDAD患者(相对于对照)的LOS均显着升高。 LOS的显着差异范围从老年患者的3.0天(95%CI≥1.4-4.6)增加到CAbx暴露患者的7.8天(95%CI≥5.7-9.9)。 HO-CDAD与老年患者(p <0.001)和肾功能不全(p = 0.012)或CAbx使用(p <0.001)的患者费用显着相关。
局限性:缺少成本数据以及定居的受感染患者的误分类。
结论:HO-CDAD患者的肾功能不全,高龄,癌症和CAbx的使用与LOS明显延长有关,CAbx的使用者是最消耗资源的。在这些人群中,应及早发现和积极治疗HO-CDAD。

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