title: Utilization of Health Services Among Adults With Recurrent Clostridium difficile Infection: A 12-Year Population-Based Study.
abstract: BACKGROUND Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. OBJECTIVE To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. METHODS We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14-57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. RESULTS We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. CONCLUSIONS Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI. Infect Control Hosp Epidemiol. 2016;1-8.
authors.affiliation: 1Kaiser Permanente Northwest Center for Health Research,Portland,Oregon.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kuntz
authors.affiliation: 2Kaiser Permanente Northern California Division of Research,Oakland,California.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Baker
authors.affiliation: 2Kaiser Permanente Northern California Division of Research,Oakland,California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kipnis
authors.affiliation: 2Kaiser Permanente Northern California Division of Research,Oakland,California.
authors.forename: Sherian Xu
authors.initials: SX
authors.lastname: Li
authors.affiliation: 2Kaiser Permanente Northern California Division of Research,Oakland,California.
authors.forename: Vincent
authors.initials: V
authors.lastname: Liu
authors.affiliation: 3Center for Observational and Real-World Evidence,Merck,Lebanon,New Jersey.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.affiliation: 3Center for Observational and Real-World Evidence,Merck,Lebanon,New Jersey.
authors.forename: Stephen
authors.initials: S
authors.lastname: Marcella
authors.affiliation: 2Kaiser Permanente Northern California Division of Research,Oakland,California.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000401:mortality* / Q000628:therapy*; D000069467:Fecal Microbiota Transplantation; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents