Feuerstadt Paul, Nelson Winnie W, Drozd Edward M, Dreyfus Jill, Dahdal David N, Wong Anny C, Mohammadi Iman, Teigland Christie, Amin Alpesh
PACT-Gasteroentrology Center, Hamden, CT; Yale University School of Medicine, New Haven, CT.
Ferring Pharmaceuticals Inc, Parsippany, NJ.
J Am Med Dir Assoc. 2022 Oct;23(10):1721-1728.e19. doi: 10.1016/j.jamda.2022.01.075. Epub 2022 Mar 11.
Estimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65 years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death.
Retrospective observational claims analysis.
Patients aged ≥65 years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods.
Using 100% Medicare Fee-for-Service claims data for 2009-2017, primary (pCDI, n = 345,893) and recurrent (rCDI: n = 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12 months before and up to 12 months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities.
CDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR) = 1.83, P < .001; rCDI: OR = 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR = 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI: +3.2 days, P < .001; rCDI: +2.6 days, P < .001), and higher total cost (pCDI: +303%, P < .001; rCDI: +297%, P < .001).
CDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden.
评估年龄≥65岁的医疗保险受益人的死亡率、成本及医疗资源利用情况，这些受益人仅经历过一次原发性艰难梭菌感染（CDI）发作或有任何复发性CDI，并了解结局与死亡之间的共变关系。
回顾性观察性索赔分析。
年龄≥65岁、向医疗保险提出住院或门诊CDI诊断索赔且在索引期前后12个月内持续参加医疗保险A、B和D部分的患者。
利用2009 - 2017年100%的医疗保险按服务收费索赔数据，识别出原发性（pCDI，n = 345,893）和复发性（rCDI：n = 151,596）CDI发作。总结发作开始前12个月及发作开始后长达12个月的人口统计学和临床特征、死亡率、医疗资源利用情况及成本（每月每位患者）。估计用于调整合并症的住院风险、住院时间（LOS）和成本的回归模型。
复发性CDI后与CDI相关的死亡几乎是原发性CDI后的10倍（25.4%比2.7%）。与幸存者相比，死者年龄更大，Charlson合并症指数得分更高，且更可能是黑人。在调整合并症后，随访期间，死者的住院率更高[pCDI：比值比（OR）= 1.83，P <.001；rCDI：OR = 2.58，P <.001]，与幸存者相比，复发性CDI死者更多地使用重症监护病房（OR = 2.34，P <.001）。死者的住院时间也更长（pCDI：+3.2天，P <.001；rCDI：+2.6天，P <.001），总成本更高（pCDI：+303%，P <.001；rCDI：+297%，P <.001）。
CDI是全因死亡率的一个重要促成诊断，尤其是对于复发性CDI。在死亡前，经历过CDI的老年医疗保险受益人比幸存者接受了更长时间、更密集且成本更高的治疗。临床医生应特别关注老年人CDI的预防、识别和适当治疗。在这一脆弱人群中，更好地减少原发性艰难梭菌感染和复发的治疗方法可以降低死亡率和经济负担。
