title: Clostridium difficile recurrence is a strong predictor of 30-day rehospitalization among patients in intensive care.
abstract: OBJECTIVE
  While incidence, mortality, morbidity, and recurrence rates of C. difficile infection (CDI) among the critically ill have been investigated, the impact of its recurrence on 30-day rehospitalization (ReAd), an important policy focus, has not been examined.
  
  
  METHODS
  Secondary analysis of a multicenter retrospective cohort study Patients Adult critically ill patients who survived their index hospitalization complicated by CDI METHODS: CDI was defined by diarrhea or pseudomembranous colitis and a positive assay for C. difficile toxins A and/or B. CDI recurrence (rCDI) was defined as diarrhea, positive C. difficile toxin and need for retreatment after cessation of therapy. Descriptive statistics and a logistic regression examined ReAd rates and characteristics, and factors that impact it.
  
  
  RESULTS
  Among 287 hospital survivors, 76 (26.5%) required ReAd (ReAd+). At baseline, the ReAd+ group did not differ significantly from the ReAd- group based on demographics, comorbidities, APACHE II scores, or ICU type. ReAd+ patients were more likely to have hypotension at CDI onset (48.7% vs 34.1%, P=.025) and to require vasopressors (40.0% vs 27.1%, P=.038); they were less likely to require mechanical ventilation (56.0% vs 77.3%, P<.001). A far greater proportion of ReAd+ than ReAd- had developed a recurrence either during the index hospitalization or within 30 days after discharge (32.89% vs 2.84%, P<.001). In a logistic regression, rCDI was a strong predictor of ReAd+ (adjusted odd ratio, 15.33, 95% confidence interval, 5.68-41.40).
  
  
  CONCLUSIONS
  Greater than 25% of all survivors of critical illness complicated by CDI require readmission within 30 days of discharge. CDI recurrence is a strong predictor of such rehospitalizations.
authors.affiliation: 1EviMedResearch Group,LLC,Goshen,MA.
authors.forename: Marya D
authors.initials: MD
authors.lastname: Zilberberg
authors.affiliation: 3Washington Hospital Center,Washington,DC.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.affiliation: 4St. Louis College of Pharmacy,St. Louis,MO.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: 5Barnes-Jewish Hospital,St. Louis,MO.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification; D003422:Critical Care; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000628:therapy; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors