Journal Review: C. diff a bad bug even at endemic levels
C. diff a bad bug even at endemic levels
Considerable impact in a nonoutbreak situation
Dubberke ER, Butler AM, Reske KA, et al. Attributable outcomes of endemic Clostridium difficile–associated disease in nonsurgical patients. Emerg Infect Dis [serial on the Internet]; July 2008. Available at http://www.cdc.gov/EID.
Even in a nonoutbreak settings, Clostridium difficile–associated disease (CDAD) had a statistically significant negative impact on patient illness and death, and the impact of CDAD persisted beyond hospital discharge, researchers found.1
Data are limited on the attributable outcomes of CDAD, particularly in CDAD-endemic settings. The authors conducted a retrospective cohort study of nonsurgical inpatients admitted for > 48 hours in 2003. The adjusted hazard ratios for readmission [hazard ratio 2.19, 95% confidence interval (CI) 1.87-2.55] and deaths within 180 days (hazard ratio 1.23, 95% CI 1.03-1.46) were significantly different among CDAD case-patients and noncase patients. In a propensity score matched-pairs analysis that used a nested subset of the cohort (N = 706), attributable length of stay attributable to CDAD was 2.8 days, attributable readmission at 180 days was 19.3%, and attributable death at 180 days was 5.7%. CDAD patients were significantly more likely than controls to be discharged to a long-term care facility or outside hospital.
"The results of this study indicate that CDAD is a major contributor to death even in nonoutbreak settings," they concluded. "In this CDAD-endemic setting, the disease was associated with a 23% higher hazard of death within 180 days after hospital admission in the multivariable cohort analysis and a 7.2% attributable mortality 61-180 days after hospital admission in the matched-pairs analysis. The attributable mortality reported is more consistent with estimates from outbreaks of the highly virulent NAP1 strain, which may have present during the study period, they noted. "The results of this study suggest that endemic CDAD can lead to significantly poorer patient outcomes, including increased hospital length of stay, death, risk for admission to a long-term-care facility, and risk for hospital readmission," they emphasized.
Even in a nonoutbreak settings, Clostridium difficileassociated disease (CDAD) had a statistically significant negative impact on patient illness and death, and the impact of CDAD persisted beyond hospital discharge, researchers found.Subscribe Now for Access
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