A Propensity Score Analysis of <i>Clostridium difficile</i> Infection among Adult Trauma Patients

Gabriel, Viktor; Grigorian, Areg; Phillips, Jacquelyn L; Schubl, Sebastian; Barrios, Cristobal; Pejcinovska, Marija; Won, Eugene; Nahmias, Jeffry

doi:10.1089/sur.2018.110

Cited by 5 publications

(5 citation statements)

References 26 publications

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Section: Resultsmentioning

confidence: 99%

“…Of the 34 775 articles identified (Figure), 119 were full-text articles, and 86 (72.3%) of those articles met the selection criteria and were included in the systematic literature review . Among these, 66 articles evaluated incidence, and 20 articles evaluated LOS . One-fifth of the studies that assessed LOS (4 studies) scored 18 or more points of the 28 points possible on the Downs and Black scale and, thus, were considered to be of higher quality.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies (Table 4) evaluated CDI-associated LOS. Sixteen studies used propensity score matching to evaluate LOS associated with CDI, 2 studies used postinfection LOS, 1 study matched on LOS from admission until either positive C difficile test results or discharge, and 1 study accounted for time to infection using a multistate model.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies 16,54,66,[79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94] (Table 4) evaluated CDI-associated LOS. Sixteen studies 54,66,[79][80][81][82][83][84][85][86][87][88][89]92,94,95 used propensity score matching to evaluate LOS associated with CDI, 2 studies 16,93 used postinfection LOS, 1 study 90 matched on LOS from admission until either positive C difficile test results or discharge, and 1 study 91 accounted for time to infection using a multistate model. Also, one of the propensity score matched-studies applied multistate modeling to account for timing of infection.…”

Section: Los Associated With CDI (20 Studies)mentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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IMPORTANCE An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. OBJECTIVE To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. DATA SOURCES MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. STUDY SELECTION Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I 2 value. Data analysis was performed in February 2019. MAIN OUTCOMES AND MEASURES Incidence of CDI and CDI-associated hospital LOS in the United States. RESULTS When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). CONCLUSIONS AND RELEVANCE Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Los Associated With CDI (20 Studies)mentioning

confidence: 99%

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Incidence and Outcomes Associated WithClostridium difficileInfections

et al. 2020

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“…10 Meanwhile several studies have shown higher in-hospital mortality rate, postoperative complications, prolonged hospitalizations, and hospital cost among surgical patients who develop CDI. 3,11,12 However, there has not been such a study investigating CDI rate and outcomes among common laparoscopic abdominal surgeries.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcome in Laparoscopic Abdominal Surgical Operations with Clostridium Difficile Infection

Alizadeh

Sullivan

et al. 2022

The American Surgeon

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Introduction: Postoperative Clostridium difficile infection (CDI) has associated morbidity, but it is unknown how it impacts different operations. We sought to determine the incidence and postoperative morbidity following abdominal surgery. Method: The National Surgical Quality Improvement Program database (2015-2019) was utilized to evaluate adult (≥18 years-old) patients who developed CDI following laparoscopic abdominal operations. Univariate and multivariate analysis were performed to evaluate outcomes. Results: A total of 973 338 patients were studied and the overall incidence of CDI was .3% within 30 days of operation. Colorectal surgery had the highest incidence of CDI (1601/167 949,1.0%) with significantly longer mean length of stay (LOS) (8.0 days± 9.0, P < .01) compared to other surgical procedures. CDI patients also had a longer mean length of stay (6.6± 8.0 vs 2.1 ± 3.6 days, P < .01) and increased mortality (1.8% vs .2%, AOR: 4.64, CI: 3.45-5.67, P < .01) compared to patients without CDI. Conclusions: This national analysis demonstrates that CDI is a significant complication following abdominal surgery and is associated with increased LOS and mortality. Furthermore, laparoscopic colorectal surgery appears to have the greatest risk of CDI. Future research is needed to determine the exact cause in order to decrease the incidence of CDI by reconsidering the protocol of antibiotic use within the high-risk population.

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Overview of infectious diseases in trauma patients

Fry¹

2024

Current Therapy of Trauma and Surgical Critical Care

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A Propensity Score Analysis of Clostridium difficile Infection among Adult Trauma Patients

Abstract: Among trauma patients admitted >48 hours CDI occurred at a rate of 0.6%, much lower than anticipated. Patients in whom CDI developed had a significantly longer hospital LOS however, had no significant difference in odds of mortality or ICU LOS compared to patients without CDI.

Cited by 5 publications

References 26 publications

Incidence and Outcomes Associated WithClostridium difficileInfections

Incidence and Outcomes Associated WithClostridium difficileInfections

Surgical Outcome in Laparoscopic Abdominal Surgical Operations with Clostridium Difficile Infection

Overview of infectious diseases in trauma patients

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