Readmissions for C. difficile infections high among elderly

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

sworcester@frontlinemedcom.com

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

sworcester@frontlinemedcom.com

LAS VEGAS – More than one in 10 patients with Clostridium difficile infection at the time of hospital discharge are readmitted for C. difficile infection within 90 days, according to findings from a review of Medicare data from 2009 to 2011.

Of a random sample of nearly 900,000 Part A inpatients and Part D prescription drug claimants during the study period, about 8,500 were hospitalized with a primary or secondary diagnosis of C. difficile infection, and of 7,042 of those who were discharged alive and who were eligible for the study, 945 (13.4%) were readmitted within 90 days, Dr. Charles M. Psoinos reported at the annual meeting of the American Association for the Surgery of Trauma.

CDC/D. Holdeman

Compared with 1,900 patients not readmitted for any reason, those who were readmitted had more baseline comorbidities (average Elixhauser index, 5.9 vs. 4.7), and a significantly shorter length of stay during the index hospitalization (9.2 vs. 11.8 days), and those older than 95 years were twice as likely as those aged 65-70 years to be readmitted, as were those with an emergent vs. nonemergent index hospitalization, said Dr. Psoinos of the University of Massachusetts, Worcester.

Further, the readmission rate was lower in the 39% of patients discharged on oral metronidazole (19%), and in the 12% discharged on oral vancomycin (28%), than among the 38% discharged with no ongoing treatment (48%), while those discharged on both oral metronidazole and vancomycin were at increased risk for readmission (odds ratio, 1.29), he said.

The 90-day all cause mortality rate was nearly doubled in those who were readmitted, compared with those who were not (17.8% vs. 8.9%; OR, 1.77), he said.

Patients who were and were not readmitted did not differ significantly with respect to age (mean of about 80 years) and race distribution, and the outcomes were adjusted for the differences in baseline comorbidities and other confounding factors.

The findings could have important implications for reducing readmissions among Medicare beneficiaries, Dr. Psoinos said.

The incidence of C. difficile infections has increased nearly eightfold in the elderly population over the last several decades, and the elderly now account for more than 70% of hospitalized patients with such infections. Recurrence rates range from 5% to 31% after cessation of therapy, and readmission rates are similar, he explained, noting that treatment recommendations for C. difficile infections are commonly based on symptoms and their severity, with oral metronidazole recommended for mild and moderate disease, vancomycin only for severe disease, and dual therapy for complicated severe disease.

Though limited by the retrospective design of the study, the findings suggest that C. difficile patients discharged from the hospital may benefit from ongoing monotherapy treatment to reduce subclinical infections and induce long-term eradication, and that elderly patients on dual therapy may benefit from continued hospitalization until they are appropriate for discharge on monotherapy.

These strategies could reduce the rate of readmissions, Dr. Psoinos concluded.

Dr. Psoinos reported having no relevant financial conflicts.

sworcester@frontlinemedcom.com