Department of Surgery, University of Massachusetts Medical School, Room S3-731, 55 Lake Avenue North, Worcester, MA, 01655, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
World J Surg. 2018 Jan;42(1):246-253. doi: 10.1007/s00268-017-4139-8.
C. difficile (CDI) has surpassed methicillin-resistant staph aureus as the most common nosocomial infection with recurrence reaching 30% and the elderly being disproportionately affected. We hypothesized that post-discharge antibiotic therapy for continued CDI treatment reduces readmissions.
We queried a 5% random sample of Medicare claims (2009-2011 Part A and Part D; n = 864,604) for hospitalizations with primary or secondary diagnosis of CDI. We compared demographics, comorbidities, and post-discharge CDI treatment (no CDI treatment, oral metronidazole only, oral vancomycin only, or both) between patients readmitted with a primary diagnosis of CDI within 90 days and patients not readmitted for any reason using univariate tests of association and multivariable models.
Of 7042 patients discharged alive, 945 were readmitted ≤90 days with CDI (13%), while 1953 were not readmitted for any reason (28%). Patients discharged on dual therapy had the highest rates of readmission (50%), followed by no post-discharge CDI treatment (43%), vancomycin only (28%), and metronidazole only (19%). Patients discharged on only metronidazole (OR 0.28) or only vancomycin (OR 0.42) had reduced odds of 90-day readmission compared to patients discharged on no CDI treatment. Patients discharged on dual therapy did not vary in odds of readmission.
Thirteen percent of patients discharged with CDI are readmitted within 90 days. Patients discharged with single-drug therapy for CDI had lower readmission rates compared to patients discharged on no ongoing CDI treatment suggesting that short-term monotherapy may be beneficial in inducing eradication and preventing relapse. Half of patients requiring dual therapy required readmission, suggesting patients with symptoms severe enough to warrant discharge on dual therapy may benefit from longer hospitalization.
艰难梭菌（CDI）已超过耐甲氧西林金黄色葡萄球菌，成为最常见的医院获得性感染，其复发率达到 30%，且老年人的感染率不成比例地升高。我们假设，出院后的抗生素治疗继续治疗 CDI 可降低再入院率。
我们查询了 Medicare 索赔的 5%随机样本（2009-2011 年 A 部分和 D 部分；n=864604），这些索赔与 CDI 的主要或次要诊断有关。我们比较了 90 天内因 CDI 而再次入院的患者和因任何其他原因而未再次入院的患者的人口统计学、合并症和出院后的 CDI 治疗（无 CDI 治疗、仅口服甲硝唑、仅口服万古霉素或两者均有），使用单变量关联检验和多变量模型进行比较。
在 7042 名存活出院的患者中，有 945 名（13%）在 90 天内因 CDI 而再次入院，而有 1953 名（28%）因任何其他原因而未再次入院。接受双联治疗的患者再入院率最高（50%），其次是无出院后 CDI 治疗（43%）、仅用万古霉素（28%）和仅用甲硝唑（19%）。与无 CDI 治疗的患者相比，仅用甲硝唑（OR 0.28）或仅用万古霉素（OR 0.42）出院的患者 90 天再入院的可能性较低。接受双联治疗的患者的再入院几率没有差异。
13%出院时有 CDI 的患者在 90 天内再次入院。与无持续 CDI 治疗的患者相比，接受单药治疗的 CDI 患者的再入院率较低，这表明短期单药治疗可能有助于根除并预防复发。需要双联治疗的一半患者需要再次入院，这表明症状严重到需要双联治疗出院的患者可能受益于更长时间的住院治疗。
