Clostridium difficile infection health disparities by race among hospitalized adults in the United States, 2001 to 2010

Argamany, Jacqueline R.; Delgado, Andrew; Reveles, Kelly R.

doi:10.1186/s12879-016-1788-4

Cited by 30 publications

(42 citation statements)

References 31 publications

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“…We suspect that this discrepancy was due to differences in the access of FMT between blacks and whites, which may be caused by disparities such as health insurance coverage, clinical access, and adequacy of long-term follow-up. Our findings are in keeping with recent studies showing health disparity and consequently use of medical services for CDI among different races 11 13 Alternatively, due perhaps to some cultural belief, black patients may find FMT less acceptable, especially when performed by colonoscopy.…”

Section: Discussionsupporting

confidence: 91%

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Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections

Jamot

Raghunathan

Patel

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To identify the factors associated with first Clostridium difficile infection (CDI) that predict fecal microbiota transplantation (FMT) for recurrent CDI DESIGN We carried out a retrospective single-center cohort study to compare the clinical characteristics of 200 patients who underwent FMT for recurrent CDI to 75 patients who did not. SETTING A single academic hospital in the United States PATIENTS Adult patients RESULTS The time from first to second CDI correlated to subsequent FMT use. Concomitant inflammatory bowel disease (IBD; P=.002), use of immunosuppressive therapy (P=.04), and use of metronidazole within 2 months before the first CDI (P=.02) correlated positively to subsequent FMT in univariate analysis. The use of oral vancomycin for first CDI was more common in those who required FMT than those who did not in univariate (P=.02) and multivariate (P=.03) analyses. In contrast, intravenous vancomycin use within 2 months before the first CDI reduced the risk for FMT in univariate P=.000003) and multivariate (P=.0001) analyses. Black patients with recurrent CDI were less likely to receive FMT than white patients (P=.00005). Patients who received FMT were also less likely to have comorbidities. CONCLUSIONS This study provides important insights into the factors predictive for FMT in patients with recurrent CDI and highlights the potential racial and medical characteristics that affect the access of the patients to FMT. Infect Control Hosp Epidemiol 2018;39:302-306.

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Section: Discussionsupporting

confidence: 91%

“…Our findings are in keeping with recent studies showing health disparity and consequently use of medical services for CDI among different races. 11,13 Alternatively, due perhaps to some cultural belief, black patients may find FMT less acceptable, especially when performed by colonoscopy. Therefore, they did not want to be referred for FMT.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections

Jamot

Raghunathan

Patel

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…Other studies have shown lower rates of CDI in both adult and pediatric populations among non-white subjects. 19,34 Our study had some limitations. This retrospective study was limited to available data in the electronic health record, which may lead to an incomplete assessment of symptoms and all potential risk factors of community-acquired CDI.…”

Section: Discussionmentioning

confidence: 94%

Epidemiology and Risk Factors for Community Associated Clostridioides difficile in Children

Miranda-Katz

Parmar

Dang

et al. 2020

The Journal of Pediatrics

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Objective To assess which risk factors are associated with community-associated Clostridioides difficile infection (CDI) in children. Study design This case control study was a retrospective review of all children 1-17 years of age with stool specimens sent for C difficile testing from January 1, 2012, to December 31, 2016. Cases and controls were children who had C difficile testing performed in the community or first 48 hours of hospital admission and >12 weeks after hospital discharge, with no prior positive C difficile testing in last 8 weeks, without other identified causes of diarrhea, and with clinical symptoms. Cases had positive confirmatory testing for C difficile. Controls had negative testing for C difficile and were matched to cases 1:1 by age and year of specimen collection. Results The overall incidence rate of community-acquired CDI in this cohort was 13.7 per 100 000 children per year. There was a substantial increase in community-acquired CDI from 9.6 per 100 000 children per year in 2012 to a peak of 16.9 per 100 000 children per year in 2015 (Cochran-Armitage test for trend P = .002). The risk factors for communityacquired CDI included non-Hispanic ethnicity; amoxicillin-clavulanate, cephalosporin, and clindamycin use within the previous 12 weeks; a previous positive C difficile test within 6 months; and increased health care visits in the last year. Conclusions As rates of community-acquired CDI are increasing, enhanced antibiotic stewardship and recognition of health care disparities may ease the burden of community-acquired CDI.

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“…Age is a known risk factor for CDI, 21 and higher rates of CDI in whites and the Northeast have been demonstrated previously in the NHDS. 27,28 CDI rates were also related to admission status (elective vs not) with patients with cancer and CDI more likely to have emergent/urgent admissions. The rate of CDI in patients with cancer increased overall during the study period, with a peak incidence in 2007 to 2008.…”

Section: Discussionmentioning

confidence: 99%

“…-2002 2003-2004 2005-2006 Year 2007-2008 20092001-2002 2003-2004 2005-2006 Year 2007-2008 20092001-2002 2003-2004 2005-2006 Year 2007-2008 2009 …”

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Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

Gupta¹,

Tariq²,

Frank³

et al. 2017

J Natl Compr Canc Netw

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Patients with cancer have several risk factors for infection (CDI), but the impact of CDI on outcomes in this population needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in patients with cancer using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Diagnosis codes were used to identify patients with cancer and CDI events. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study CDI incidence and CDI-associated outcomes. Analyses were performed using SAS version 9.4. During the 10-year study period, 20.1 million discharges had a cancer diagnosis. CDI developed in 1.09% of patients with cancer versus 0.77% of patients without cancer (adjusted odds ratio [aOR], 1.28; 95% CI, 1.28-1.29;<.001). The incidence of CDI in patients with cancer increased during the 10-year study period (64.7 per 10,000 discharges in 2001-2002 to 109.1 in 2009-2010; <.001). In multivariable analysis, compared with patients with cancer without CDI, patients with cancer and CDI had a longer mean LOS (5.67 days; 95% CI, 5.39-5.94) and higher rates of in-hospital mortality (aOR, 1.18; 95% CI, 1.16-1.20) and discharge to a care facility (aOR, 1.74; 95% CI, 1.72-1.75; all <.001). In this national database, CDI incidence increased significantly in patients with cancer over the study period and was associated with prolonged hospitalization, increased mortality, and discharge to a care facility. Despite increased attention, CDI remained a serious infection and merits appropriate prevention and management.

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Clostridium difficile infection health disparities by race among hospitalized adults in the United States, 2001 to 2010

Cited by 30 publications

References 31 publications

Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections

Factors Associated with the Use of Fecal Microbiota Transplant in Patients with Recurrent Clostridium difficile Infections

Epidemiology and Risk Factors for Community Associated Clostridioides difficile in Children

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis

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