title: Impact of Clostridium difficile recurrence on hospital readmissions.
abstract: BACKGROUND
  The impact of recurrent Clostridium difficile infections (CDIs) on hospital readmissions is unknown. The objective of this study was to determine whether recurrent CDI was independently associated with the number of hospital readmissions and days readmitted.
  
  
  METHODS
  We performed a retrospective cohort study at an academic, urban, tertiary care hospital. Data were collected from electronic medical records and supplemented with chart review. CDI patients were followed for 180 days to ascertain the number of hospital readmissions and total days readmitted. Univariate and multivariable negative binomial regression models were used to evaluate factors, including CDI recurrence, associated with hospital readmissions.
  
  
  RESULTS
  The study included 3,950 patients with CDI from 2003-2009, including 413 patients with recurrent CDI. Recurrent CDI patients were significantly more likely to have at least 1 readmission (85% vs 41%; P < .001) and had more days readmitted (mean = 18.6 vs 7.6; P < .001) than patients without recurrent CDI. In multivariable analysis, recurrent CDI was independently associated with number of readmissions (rate ratio = 2.54; 95% confidence interval [CI], 2.21-2.91) and days readmitted (rate ratio = 3.97; 95% CI, 3.11-5.08) after adjustment for demographics, comorbidities, and medications.
  
  
  CONCLUSIONS
  Recurrent CDI patients are significantly more likely than patients without a recurrence to be readmitted and spend increased time readmitted to the hospital.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO; Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO. Electronic address: molsen@dom.wustl.edu.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO; Division of General Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Reske
authors.affiliation: Department of Health Services Research, EviMed Research Group, LLC, Goshen, MA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
authors.forename: Marya
authors.initials: M
authors.lastname: Zilberberg
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D000069349:Linezolid / Q000627:therapeutic use; D015999:Multivariate Analysis; D010359:Patient Readmission; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D024841:Fluoroquinolones; D014640:Vancomycin; D000069349:Linezolid
keywords: Clostridium difficile; Cohort; Epidemiology; Readmission; Recurrence