A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

2015 ◽  
Vol 36 (12) ◽  
pp. 1409-1416 ◽  
Author(s):  
Sara Y. Tartof ◽  
Gunter K. Rieg ◽  
Rong Wei ◽  
Hung Fu Tseng ◽  
Steven J. Jacobsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Southern California ◽  
Skilled Nursing Facility ◽  
Antibiotic Exposure ◽  
Kaiser Permanente ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Transfer Factors ◽  
Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

Variations in Nationwide Readmission Patterns after Umbilical Hernia Repair

2019 ◽  
Vol 85 (5) ◽  
pp. 494-500 ◽  
Author(s):  
Sarah A. Eidelson ◽  
Joshua Parreco ◽  
Michelle B. Mulder ◽  
Arjuna Dharmaraja ◽  
L. Renee Hilton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hernia Repair ◽  
Umbilical Hernia ◽  
Skilled Nursing Facility ◽  
Median Cost ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
For Profit ◽  
Umbilical Hernia Repair ◽  
Comorbidity Index

Up to one in three readmissions occur at a different hospital and are thus missed by current quality metrics. There are no national studies examining 30-day readmission, including to different hospitals, after umbilical hernia repair (UHR). We tested the hypothesis that a large proportion were readmitted to a different hospital, that risk factors for readmission to a different hospital are unique, and that readmission costs differed between the index and different hospitals. The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted for UHR, and cost was calculated. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. There were 102,650 admissions for UHR and 8.9 per cent readmissions, of which 15.8 per cent readmissions were to a different hospital. The most common reason for readmission was infection (25.8%). Risk factors for 30-day readmission to any hospital include bowel resection, index admission at a for-profit hospital, Medicare, Medicaid, and Charlson Comorbidity Index ≥ 2. Risk factors for 30-day readmission to a different hospital include elective operation, drug abuse, discharge to a skilled nursing facility, and leaving against medical advice. The median cost of initial admission was higher in those who were readmitted ($16,560 [$10,805–$29,014] vs $11,752 [$8151–$17,724], P < 0.01). The median cost of readmission was also higher among those readmitted to a different hospital ($9826 [$5497–$19,139] vs $9227 [$5211–$16,817], P = 0.02). After UHR, one in six readmissions occur at a different hospital, have unique risk factors, and are costlier. Current hospital benchmarks fail to capture this sub-population and, therefore, likely underestimate UHR readmissions.

scholarly journals Risk Factors for Colistin Resistance among Gram-Negative Rods andKlebsiella pneumoniaeIsolates

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Stefan E. Richter ◽  
Loren Miller ◽  
Daniel Z. Uslan ◽  
Douglas Bell ◽  
Karol Watson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Skilled Nursing Facility ◽  
Resistant Organism ◽  
Neurologic Disease ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Gram Negative ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Prior Infection

ABSTRACTInfections due to colistin-resistant (Colr) Gram-negative rods (GNRs) and colistin-resistantKlebsiella pneumoniaeisolates in particular result in high associated mortality and poor treatment options. To determine the risk factors for recovery on culture of ColrGNRs and ColrK. pneumoniae, analyses were chosen to aid decisions at two separate time points: the first when only Gram stain results are available without any bacterial species information (corresponding to the ColrGNR model) and the second when organism identification is performed but prior to reporting of antimicrobial susceptibility testing results (corresponding to the ColrK. pneumoniaemodel). Cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. After excluding bacteria that were intrinsically resistant to colistin, a total of 28,512 GNR isolates (4,557K. pneumoniaeisolates) were analyzed, 128 of which were Colr(i.e., MIC > 2 μg/ml), including 68 of which that were ColrK. pneumoniae. In multivariate analysis, risk factors for ColrGNRs were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, prior infection with a carbapenem-resistant organism, and receipt of ventilatory support (c-statistic = 0.81). Risk factors for ColrK. pneumoniaespecifically were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, receipt of an anti-methicillin-resistantStaphylococcus aureusantimicrobial in the last 90 days, and prior infection with a carbapenem-resistant organism (c-statistic = 0.89). A scoring system derived from these models can be applied by providers to guide empirical antimicrobial therapy in patients with infections with suspected ColrGNR and ColrK. pneumoniaeisolates.

scholarly journals Discharge to the skilled nursing facility: patient risk factors and perioperative outcomes after total knee arthroplasty

2019 ◽  
Vol 7 (4) ◽  
pp. 65-65 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Chukwuweike Gwam ◽  
Sergio M. Navarro ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Perioperative Outcomes ◽  
Nursing Facility ◽  
Patient Risk ◽  
Skilled Nursing ◽  
Total Knee

Risk Factors for Readmission in Patients With Cancer Comanaged by Hospitalists

2016 ◽  
Vol 32 (5) ◽  
pp. 526-531 ◽  
Author(s):  
Joshua S. Shapiro ◽  
Michael S. Humeniuk ◽  
Mustaqeem A. Siddiqui ◽  
Neelima Bonthu ◽  
Darrell R. Schroeder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Readmission ◽  
Medical Oncology ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Patients With Cancer ◽  
Patient Demographics ◽  
Complex Patient ◽  
Cancer Types

Little is known about which variables put patients with cancer at risk for 30-day hospital readmission. Comanagement of this often complex patient population by specialists and hospitalists has become increasingly common. This retrospective study examined inpatients with cancer comanaged by hospitalists, hematologists, and oncologists to determine the rate of readmission and factors associated with readmission. Patients in this cohort had a readmission rate of 23%. Patients who were discharged to a skilled nursing facility (odds ratio [OR] = 0.34) or hospice (OR = 0.11) were less likely to have 30-day readmissions, whereas patients who had surgery (OR = 3.16) during their index admission were more likely. Other factors, including patient demographics, cancer types, and hospitalization interventions and events, did not differ between patients who were readmitted and those who were not. These findings contribute to a growing body of literature identifying risk factors for readmission in medical oncology and hematology patients.

scholarly journals 1501. Risk Factors for Clostridium difficile Infection in Patients Hospitalized with Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S546-S546
Author(s):  
Abhishek Deshpande ◽  
Marya Zilberberg ◽  
Pei-Chun Yu ◽  
Peter Imrey ◽  
Michael Rothberg
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Laboratory Test ◽  
Clostridium Difficile Infection ◽  
Skilled Nursing Facility ◽  
Community Acquired Pneumonia ◽  
Small Sample ◽  
Skilled Nursing ◽  
Healthcare Facilities ◽  
Multiple Logistic Regression Modeling

Abstract Background Patients with community-acquired pneumonia (CAP) are often prescribed broad-spectrum antibiotics, putting them at risk for developing Clostridium difficile infection (CDI). Previous studies of risk factors for CDI in this population have suffered from small sample sizes. We examined the risk factors for CDI in patients hospitalized with CAP using a large US database. Methods We included adult patients admitted with CAP 2010–2015 to 175 US hospitals participating in Premier and providing administrative and microbiological data. Patients were identified as having CAP if they had a diagnosis of pneumonia, a chest radiograph, and were treated with antimicrobials on day 1 and for ≥3 days. Incident CDI was identified with ICD-9 diagnosis code (not present on admission) and a positive laboratory test. We used descriptive statistics and mixed multiple logistic regression modeling to mutually adjust and evaluate risk factors previously suggested in the CDI literature. Results Among 148,417 inpatients with pneumonia treated with antibiotics, 789 (0.53%) developed CDI. The median age was 75 years, and 53% were female. Compared with patients with no CDI, those with CDI were older (75 vs. 72 years), had more comorbidities (5 vs. 3), and were more likely to be admitted from SNF (15.7% vs. 7.3%) or hospitalized in the past 3 months (11.8% vs. 7.1) (all comparisons P < 0.001). After multivariable adjustment, factors significantly associated with development of CDI included increasing age, admission from a skilled nursing facility, and receipt of piperacillin/tazobactam, aztreonam or intravenous vancomycin (Figure 1). Receipt of third-generation cephalosporins or fluoroquinolones was not an independent predictor of CDI. Conclusion In a large US inpatient sample hospitalized for pneumonia and treated with antimicrobials, only 0.53% of the patients developed CDI as defined by an ICD-9 code and positive laboratory test. Reducing the exposure to healthcare facilities and certain high-risk antibiotics may reduce the burden of CDI in patients with CAP. Disclosures All authors: No reported disclosures.

scholarly journals Use of Electronic Data to Identify Risk Factors Associated with Clostridium difficile Infection (CDI) and to Develop CDI Risk Scores

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S403-S403
Author(s):  
Laurie Aukes ◽  
Bruce Fireman ◽  
Edwin Lewis ◽  
Julius Timbol ◽  
John Hansen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Risk Score ◽  
Skilled Nursing Facility ◽  
Risk Scores ◽  
Office Visits ◽  
Skilled Nursing ◽  
Factors Associated ◽  
C Statistic ◽  
Grant Recipient

Abstract Background Clostridium difficile is a major cause of severe diarrhea in the U.S. We described characteristics of Kaiser Permanente Northern California (KPNC) members with C. difficile infection (CDI), identified risk factors associated with CDI, and developed risk scores to predict who may develop CDI. Methods Retrospective cohort study with all KPNC members ≥18 years old from May 2011 to July 2014 comparing demographic and clinical characteristics for those with and without lab-confirmed incident CDI. We included CDI risk factors in logistic regression models to estimate the risk of developing future CDI after an Identification Recruitment Date (IRD), a time when an individual might be a good candidate for a C. difficile vaccine clinical trial. Two risk score models were created and cross validated (70% of the data used for development and 30% for testing). Results During the study period, there were 9,986 CDI cases and 2,230,354 members without CDI. CDI cases tended to be ≥65 years old (59% vs.. 21%), female (61% vs. 53%), and white race (70% vs. 53%), with more hospitalizations (42% vs. 3%), emergency room visits (51% vs. 14%), and skilled nursing facility stays (25% vs. 0.6%) in the year prior to CDI compared with members without CDI. At least 10 office visits within the prior year (53% vs. 16%), use of antibiotics in last 12 weeks (81% vs. 11%), proton pump inhibitors in the last year (36% vs. 7%), and multiple medical conditions within the prior year (e.g., chronic kidney disease, congestive heart failure, and pneumonia) were important risk factors for CDI. Using a hospital discharge event as the IRD, our risk score model yielded excellent performance in predicting the likelihood of developing CDI in the subsequent 31 – 365 days (C-statistic of 0.851). Using a random date as the IRD, our model also predicted CDI risk in the subsequent 1–30 days (C-statistic 0.658) and 31–365 days (C-statistic 0.722) reasonably well. Conclusion CDI can be predicted by increasing age, medications, comorbidities and healthcare exposure, particularly ≥10 office visits, hospitalizations, and skilled nursing stays in the prior year and recent antibiotics. Such risk factors can be used to identify high-risk populations for C. difficile vaccine clinical studies. Disclosures H. Yu, Pfizer, Inc.: Employee, Salary; B. Cai, Pfizer, Inc.: Employee, Salary; E. Gonzalez, Pfizer, Inc.: Employee, Salary; J. Lawrence, Pfizer, Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Sciences: Investigator, Grant recipient; Pfizer: Investigator, Grant recipient

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