Utilization of Health Services Among Adults With RecurrentClostridium difficileInfection: A 12-Year Population-Based Study

Abstract

BACKGROUND Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. OBJECTIVE To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. METHODS We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. RESULTS We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. CONCLUSIONS Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI.

Risk of complications and mortality following recurrent and non-recurrent Clostridioides difficile infection: a retrospective observational database study in England

“…Additionally, mortality and complications were increased significantly in patients with recurrent CDI compared with non-recurrent CDI, findings which align with earlier research in the USA [19,21]. It is, however, important to note that our study population was older and had more comorbidities than some populations studied in North America [19,20,35] and Europe [31]. This age difference is similar to findings from studies of fidaxomicin for the treatment of CDI, in which the median age in the UK was 70e81 years [37] whilst in North America and Europe, the mean age was 61e63 years [38,39].…”

“…Interestingly, in a study of CDI in Scotland [17], the 30-day all-cause mortality rate of 17.5% was similar to the rate we observed in England (16.3%), despite the use of differing time periods and database methodology. Additionally, mortality and complications were increased significantly in patients with recurrent CDI compared with non-recurrent CDI, findings which align with earlier research in the USA [19,21]. It is, however, important to note that our study population was older and had more comorbidities than some populations studied in North America [19,20,35] and Europe [31].…”

Clostridium difficile infection increases acute and chronic morbidity and mortality

“…In contrast, Kuntz reported much lower attributable mortality risk of 4% due to non-recurrent CDI in adult Kaiser Health Plan members. 11 One possible explanation for the lower CDI mortality risk in the Kuntz study was the requirement of a negative CDI test in control patients, thus selecting for control patients suspected of having CDI with likely higher underlying severity of illness than a non-tested group.…”

The Impact of Recurrent Clostridium difficile Infection on Patients’ Prevention Behaviors

“…A recent study of utilization following RCDI found a 155% higher rate of 1-year mortality compared to matched patients who did not have CDI. 12 We do not know how these individuals may have responded to the survey.…”