title: Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients.
abstract: Data are limited on the attributable outcomes of Clostridium difficile-associated disease (CDAD), particularly in CDAD-endemic settings. We conducted a retrospective cohort study of nonsurgical inpatients admitted for >/=48 hours in 2003 (N = 18,050). The adjusted hazard ratios for readmission (hazard ratio 2.19, 95% confidence interval [CI] 1.87-2.55) and deaths within 180 days (hazard ratio 1.23, 95% CI 1.03-1.46) were significantly different among CDAD case-patients and noncase patients. In a propensity score matched-pairs analysis that used a nested subset of the cohort (N = 706), attributable length of stay attributable to CDAD was 2.8 days, attributable readmission at 180 days was 19.3%, and attributable death at 180 days was 5.7%. CDAD patients were significantly more likely than controls to be discharged to a long-term-care facility or outside hospital. Even in a nonoutbreak setting, CDAD had a statistically significant negative impact on patient illness and death, and the impact of CDAD persisted beyond hospital discharge.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.forename: Anne M
authors.initials: AM
authors.lastname: Butler
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Reske
authors.forename: Denis
authors.initials: D
authors.lastname: Agniel
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Gina
authors.initials: G
authors.lastname: D'Angelo
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000382:microbiology; D019353:Endemic Diseases; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000382:microbiology; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies