Risk Factors for Recurrent Clostridium difficile Infections and Strategies to Decrease Readmissions in a Community Hospital.
BACKGROUND
Currently there are no universally accepted approaches for the prevention of recurrent Clostridium difficile infections (CDI) following the initial infection. Several studies have identified common risk factors for the emergence of recurrent CDI. Identifying patients at high risk for recurrent CDI through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. A vancomycin hydrochloride-tapered regimen may be an effective treatment option for the prevention of recurrent CDI following the initial infection.


METHODS
In this single-center, prospective study, we examined the efficacy of orally administered vancomycin-tapered regimens for the prevention of recurrent CDI in high-risk patients. High-risk patients were identified using patient risk factors found in a retrospective chart review. The primary objective was to decrease hospital readmissions for recurrent CDI. The secondary objective was to improve the discharge coordination-of-care process by providing a pharmacy benefits evaluation, which ensured vancomycin affordability and assistance in prescription attainment, and discharge counseling.


RESULTS
Of the 83 patients enrolled in the study, 5 experienced recurrent CDI (6%). Memorial Health Care System's (Chattanooga, Tennessee) historical recurrent CDI rate was 8.2%. Thirty-one of the 83 patients received a vancomycin-tapered regimen following their initial infection (37%). A pharmacy benefits evaluation was performed on 35 of the 57 patients who were discharged home on vancomycin (61%).


CONCLUSIONS
Vancomycin-tapered regimens may provide a cost-effective method for the prevention of recurrent CDI following an initial infection in patients at high risk for recurrence.
Pharmacy Department, Memorial Health Care System, Chattanooga, Tennessee. Corresponding author: Darrin Majors, PharmD, BCPS , 2525 deSales Avenue, Chattanooga, TN 37404; phone: 423-495-8380 ; fax: 423-495-6703; e-mail: darrin_majors@memorial.org.
Darrin
D
Majors
Pharmacy Department, Memorial Health Care System, Chattanooga, Tennessee. Corresponding author: Darrin Majors, PharmD, BCPS , 2525 deSales Avenue, Chattanooga, TN 37404; phone: 423-495-8380 ; fax: 423-495-6703; e-mail: darrin_majors@memorial.org.
Patrick
P
Ellis
hospital readmissions; recurrent Clostridium difficile; risk factors; vancomycin taper