Elderly at high risk for CDI hospital readmission

Issue: June 2014

CHICAGO — Older patients with more comorbidities who were admitted to the hospital primarily because of a Clostridium difficile infection are at the highest risk for readmission to the hospital for recurrence, according to research presented here at Digestive Disease Week.

“People older than 65 have about an eightfold increased risk for C. difficile and also a higher risk of recurrence,” Courtney Collins, MD, of the department of surgery at the University of Massachusetts Medical School, told Infectious Disease News. “We saw approximately a 10% readmission rate, which is a bit higher than the typical literature reports. They were also more likely to be readmitted within the first 2 months after discharge from the index hospital stay.”

Courtney Collins

Collins and colleagues evaluated the readmission rates and the patient characteristics of older patients with CDI using a 5% national random sample of Medicare claims data from 2009 to 2011. They identified patients with CDI by ICD-9 codes. They compared characteristics of the index hospitalization for CDI for patients who were readmitted for CDI and not readmitted for CDI and evaluated the independent predictors of CDI readmission.

The study included 8,465 patients with CDI, of whom 7,672 were discharged alive. Among these patients, 721 were readmitted for CDI. Among the patients readmitted, 50% were readmitted by 25 days and 80% were readmitted by 73 days. Collins said the biggest risk factor for CDI readmission was interim hospital exposure (HR=3.9; 95% CI, 3.3-4.6). Other risk factors included more comorbidities, additional antibiotic use after first hospitalization, and CDI as a primary diagnosis during the index hospitalization. A longer length of stay and discharge disposition did not increase the risk.

“The post-discharge time of 2 months is the most important time frame in which patients were readmitted, and it speaks to the importance of discharge planning for elderly patients with C. difficile,” Collins said.

She said to minimize the risk factors, it is important to not give antibiotics to patients recently discharged after hospitalization for CDI, if possible, especially within the 2 months post-discharge. In addition, physicians should be cognizant of the fact that elderly patients who were recently discharged after a CDI are at high risk for a recurrence.

“Before sending a patient home after CDI, the patient should be well on the way to being cured,” Collins said. “Patients that still have loose stools or whose symptoms are not getting better are probably not ready to be discharged, especially if there is concern with antibiotic compliance.” – by Emily Shafer

For more information:

Collins C. #972. Presented at: Digestive Disease Week 2014; May 3-6, 2014; Chicago.

Disclosure: Collins reports no relevant financial disclosures.