A retrospective analysis of clinical characteristics, hospitalization, and functional outcomes in residents with and without Clostridium difficile infection in US long-term care facilities. (June 2014)

• Record Type: Journal Article
• Authors: Friedman, Howard S.; Navaratnam, Prakash; Reardon, Gregory; High, Kevin P.; Strauss, Marcie E.
• Is Part Of: Current medical research and opinion. Volume 30:Number 6(2014:Jun.)
• Page Start: 1121
• Page End: 1130
• Publication Date: 2014-06
• Subjects: Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1185/03007995.2014.895311
• Languages: English
• ISSNs: 0300-7995

Abstract

<abstract> <title>Abstract</title> <sec id="ss1"> <title>Objective:</title> <p>Patients in long-term care (LTC) are at increased risk for acquiring <italic>Clostridium difficile</italic> infection (CDI). We compared the characteristics and outcomes of matched cohorts with and without CDI in the LTC setting.</p> </sec> <sec id="ss2"> <title>Methods:</title> <p>Using a retrospective cohort design, demographic characteristics, Minimum Data Set (MDS 2.0) assessments (years 2007–2010), and pharmacy records of residents were analyzed. Residents were required to have a CDI diagnosis, ≥1 MDS 2.0 assessment ≤120 days pre- and post-index event, and receipt of metronidazole (MET) or vancomycin (VAN) within ±7 days of index date. Baseline characteristics were compared between cases and controls matched 1:3 on age, gender, and index year. Cox regression (CR) analysis evaluated the relationship between CDI status, and post-index mortality and hospitalization.</p> </sec> <sec id="ss3"> <title>Results:</title> <p>A total of 1145 CDI residents were matched with 3488 non-CDI residents. A second sample used propensity score methods. CDI vs. non-CDI residents had a higher baseline comorbidity burden (Charlson score: 3.0 ± 1.9 vs. 2.2 ± 1.8, respectively), and were more likely to have had a recent hospitalization (63% vs. 9%, respectively) and shorter mean pre-index continuous length of stay (cLOS) in the LTC (386.4 d ± 536.3 d vs. 568.3 d ± 567.4 d, respectively), all <italic>P</italic> < 0.0001. CR analyses of both samples indicated that CDI was strongly associated with shorter times to hospitalization and mortality (hazard ratio (HR) = 1.3, <italic>P</italic> = 0.023 and 2.2, <italic>P</italic> < 0.0001, respectively; propensity-matched group). Pre-index LTC cLOS also remained an important variable in the CR analysis and was the strongest predictor of post-index hospitalization and mortality (HR = 0.999 and 0.996, respectively, <italic>P</italic> < 0.0001), indicating that residents with longer pre-index LTC cLOS had longer times to post-index hospitalization and mortality. Our reliance on the MDS records for case identification was our chief limitation; misclassification was mitigated by our requirement to include CDI treatment as part of our inclusion criteria.</p> </sec> <sec id="ss4"> <title>Conclusions:</title> <p>Understanding factors that put LTC patients at risk for CDI can help guide better management and improvement of patient outcomes.</p> </sec> </abstract>