Amin Alpesh, Nelson Winnie W, Dreyfus Jill, Wong Anny C, Mohammadi Iman, Teigland Christie, Dahdal David N, Feuerstadt Paul
UCI Medical Center, 101 The City Drive, City Tower, Suite 500, Orange, CA 92868, USA.
Ferring Pharmaceuticals Inc., Parsippany, NJ, USA.
Ther Adv Infect Dis. 2022 Apr 29;9:20499361221095679. doi: 10.1177/20499361221095679. eCollection 2022 Jan-Dec.
To describe mortality, healthcare resource utilization (HRU), and costs among Medicare beneficiaries with primary infection (pCDI) or recurrent CDI (rCDI), with and without sepsis.
We conducted a retrospective observational study of 100% Medicare Fee-for-Service claims from adults aged ⩾ 65 years with ⩾1 CDI episode between 1 January 2009 and 31 December 2017. Patients were continuously enrolled in Medicare Parts A/B/D 12 months before and up to 12 months after pCDI. ICD-9/10 codes defined CDI using ⩾1 inpatient claim, or ⩾1 outpatient claim plus ⩾1 claim for CDI treatment. The pCDI episode ended after 14 days without a CDI claim. rCDI episodes started within 8 weeks from the end of a previous CDI episode. ICD-9/10 codes identified all-cause sepsis over 12 month follow-up.
Of 497,489 CDI patients, 41.0% ( = 203,888) had sepsis; 57.7% with sepsis died 32.4% without sepsis. Among patients with pCDI only ( = 345,893) or ⩾1 rCDI ( = 151,596), 39.2% and 45.1% suffered sepsis, respectively. All-cause hospitalizations were frequent for all cohorts (range: 81-99%). Among patients who died, those with sepsis without had more-frequent intensive care unit (ICU) use (pCDI: 29% 15%; rCDI: 65% 34%), longer hospital stays (pCDI: 12 10 days; rCDI: 12 9 days), and higher per-patient-per-month costs (pCDI: $34,841 $22,753; rCDI: $42,269 $25,047). In both cohorts, sepsis patients who survived had higher total costs and all-cause HRU than those without sepsis. All < 0.001 above.
Sepsis was common among Medicare beneficiaries with CDI. CDI patients with sepsis, especially after an rCDI, experienced higher mortality, HRU, and costs compared with those without sepsis.
描述患有原发性艰难梭菌感染（pCDI）或复发性艰难梭菌感染（rCDI）且伴有或不伴有脓毒症的医疗保险受益人的死亡率、医疗资源利用（HRU）及成本。
我们对2009年1月1日至2017年12月31日期间年龄≥65岁且有≥1次艰难梭菌感染发作的成年人的100%医疗保险按服务付费索赔进行了一项回顾性观察研究。患者在pCDI发作前12个月及发作后长达12个月持续参加医疗保险A/B/D部分。国际疾病分类第九版/第十版（ICD - 9/10）编码使用≥1次住院索赔或≥1次门诊索赔加≥1次艰难梭菌感染治疗索赔来定义艰难梭菌感染。pCDI发作在连续14天无艰难梭菌感染索赔后结束。rCDI发作在前一次CDI发作结束后8周内开始。ICD - 9/10编码在12个月的随访中识别全因性脓毒症。
在497,489例艰难梭菌感染患者中，41.0%（n = 203,888）患有脓毒症；患有脓毒症的患者中有57.7%死亡，未患脓毒症的患者中有32.4%死亡。仅患有pCDI（n = 345,893）或≥1次rCDI（n = 151,596）的患者中，分别有39.2%和45.1%患有脓毒症。所有队列的全因性住院都很频繁（范围：81 - 99%）。在死亡患者中，患有脓毒症的患者比未患脓毒症的患者更频繁地使用重症监护病房（ICU）（pCDI：29%对15%；rCDI：65%对34%），住院时间更长（pCDI：12天对10天；rCDI：12天对9天），且每位患者每月成本更高（pCDI：34,841美元对22,753美元；rCDI：42,269美元对25,047美元）。在两个队列中，存活的脓毒症患者比未患脓毒症的患者有更高的总成本和全因性医疗资源利用。上述所有p值均<0.001。
脓毒症在患有艰难梭菌感染的医疗保险受益人中很常见。与未患脓毒症的患者相比，患有脓毒症的艰难梭菌感染患者，尤其是rCDI后患者，死亡率、医疗资源利用及成本更高。
