title: Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program.
abstract: BACKGROUND
  Both Clostridium [corrected] difficile infection (CDI) rates in hospitals and interest in reducing 30-day readmission rates have increased dramatically in the United States. The objective of this study was to characterize the burden of CDI on 30-day hospital readmissions at a tertiary care health-system.
  
  
  METHODS
  A patient discharge database was used to identify patients with a CDI diagnosis (ICD-9 code 008.45) during their stay in 2012. Patients were classified as index admissions (CDI discharges) or 30-day readmissions (CDI readmissions). Readmission rates, length of stay (LOS), and time to readmission were assessed among CDI readmissions.
  
  
  RESULTS
  Among discharges from the health system (n = 51,353), 615 were diagnosed with CDI (1%). Thirty-day readmissions were more common among CDI discharges (30.1%) than non-CDI discharges (14.4%). Average LOS for CDI readmissions was 5-6 days longer than non-CDI readmissions. Time to readmission was shorter among CDI discharges diagnosed on admission than CDI discharges diagnosed later during their hospital stay (median, 7 days).
  
  
  CONCLUSIONS
  Reductions in hospital-onset CDI and readmission of patients with an index CDI can provide tremendous cost savings to hospitals. This calls for better infection control and antibiotic stewardship measures toward CDI management in the hospital and as patients transition to the next level of care.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI. Electronic address: tchopra@med.wayne.edu.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Anupama
authors.initials: A
authors.lastname: Neelakanta
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dombecki
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Reda A
authors.initials: RA
authors.lastname: Awali
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Sarit
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Detroit, MI.
authors.forename: Paru
authors.initials: P
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: 30-day readmissions; Centers for Medicare and Medicaid Services; Clostridium difficile