World Journal of Surgery

, Volume 42, Issue 1, pp 246–253 | Cite as

Post-hospitalization Treatment Regimen and Readmission for C. difficile Colitis in Medicare Beneficiaries

  • Charles M. Psoinos
  • Courtney E. Collins
  • M. Didem Ayturk
  • Frederick A. Anderson
  • Heena P. Santry
Original Scientific Report



C. difficile (CDI) has surpassed methicillin-resistant staph aureus as the most common nosocomial infection with recurrence reaching 30% and the elderly being disproportionately affected. We hypothesized that post-discharge antibiotic therapy for continued CDI treatment reduces readmissions.

Study design

We queried a 5% random sample of Medicare claims (2009–2011 Part A and Part D; n = 864,604) for hospitalizations with primary or secondary diagnosis of CDI. We compared demographics, comorbidities, and post-discharge CDI treatment (no CDI treatment, oral metronidazole only, oral vancomycin only, or both) between patients readmitted with a primary diagnosis of CDI within 90 days and patients not readmitted for any reason using univariate tests of association and multivariable models.


Of 7042 patients discharged alive, 945 were readmitted ≤90 days with CDI (13%), while 1953 were not readmitted for any reason (28%). Patients discharged on dual therapy had the highest rates of readmission (50%), followed by no post-discharge CDI treatment (43%), vancomycin only (28%), and metronidazole only (19%). Patients discharged on only metronidazole (OR 0.28) or only vancomycin (OR 0.42) had reduced odds of 90-day readmission compared to patients discharged on no CDI treatment. Patients discharged on dual therapy did not vary in odds of readmission.


Thirteen percent of patients discharged with CDI are readmitted within 90 days. Patients discharged with single-drug therapy for CDI had lower readmission rates compared to patients discharged on no ongoing CDI treatment suggesting that short-term monotherapy may be beneficial in inducing eradication and preventing relapse. Half of patients requiring dual therapy required readmission, suggesting patients with symptoms severe enough to warrant discharge on dual therapy may benefit from longer hospitalization.



This research was supported in part by the following Grants to Dr. Heena Santry (89L2TR000160 KL2 TR000160-05, ME-1310-07682, and R01 HS022694-01A1). The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors of this paper have no conflicts of interest to report.


  1. 1.
    Miller BA, Chen LF, Sexton DJ et al (2011) Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile Infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 32:387–390CrossRefPubMedGoogle Scholar
  2. 2.
    Naggie S, Miller BA, Zuzak KB et al (2011) A case-control study of community-associated Clostridium difficile infection: no role for proton pump inhibitors. Am J Med 124(276):e271–e277Google Scholar
  3. 3.
    Karlstrom O, Fryklund B, Tullus K et al (1998) A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 26:141–145CrossRefPubMedGoogle Scholar
  4. 4.
    Collins CE, Ayturk MD, Flahive JM et al (2014) Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries. J Am Coll Surg 218(1141–1147):e1141CrossRefGoogle Scholar
  5. 5.
    Takahashi M, Mori N (2014) Bito S Multi-institution case-control and cohort study of risk factors for the development and mortality of Clostridium difficile infections in Japan. BMJ Open 4:e005665CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Young GP, Bayley N, Ward P et al (1986) Antibiotic-associated colitis caused by Clostridium difficile: relapse and risk factors. Med J Aust 144(303–30):6Google Scholar
  7. 7.
    Bartlett JG (2002) Clinical practice. Antibiotic-associated diarrhea. New Engl J Med 346(334–33):9Google Scholar
  8. 8.
    Eyre DW, Walker AS, Wyllie D et al (2012) Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clin Infect Dis 55(Suppl 2):S77–S87CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Deshpande A, Pasupuleti V, Thota P et al (2015) Risk factors for recurrent Clostridium difficile infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 36(4):452–460CrossRefPubMedGoogle Scholar
  10. 10.
    Dial S, Delaney JA, Barkun AN et al (2005) Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 294(2989–299):5Google Scholar
  11. 11.
    Taori SK, Wroe A, Hardie A et al (2014) A prospective study of community-associated Clostridium difficile infections: the role of antibiotics and co-infections. J Infect 69(134–14):4Google Scholar
  12. 12.
    Reveles KR, Lee GC, Boyd NK et al (2014) The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010. Am J Infect Control 42:1028–1032CrossRefPubMedGoogle Scholar
  13. 13.
    Cohen SH, Gerding DN, Johnson S et al (2010) Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 31:431–455CrossRefPubMedGoogle Scholar
  14. 14.
    Teasley DG, Gerding DN, Olson MM et al (1983) Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet 2:1043–1046CrossRefPubMedGoogle Scholar
  15. 15.
    Wenisch C, Parschalk B, Hasenhundl M et al (1996) Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile—associated diarrhea. Clin Infect Dis 22:813–818CrossRefPubMedGoogle Scholar
  16. 16.
    Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36(8–2):7Google Scholar
  17. 17.
    Collins CE, Ayturk MD, Anderson FA Jr et al (2015) Predictors and outcomes of readmission for Clostridium difficile in a national sample of medicare beneficiaries. J Gastrointest Surg 19:88–99 (discussion 99) CrossRefPubMedGoogle Scholar
  18. 18.
    Pepin J, Valiquette L, Alary ME et al (2004) Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity CMAJ. Can Med Assoc J 171:466–472CrossRefGoogle Scholar
  19. 19.
    Vojtilova L, Freibergerova M, Jurankova J et al (2011) A study of patients with Clostridium difficile infection hospitalized at Brno Clinic of Infectious Diseases in 2007–2010. Klinicka Mikrobiologie a Infekcni Lekarstvi 17:208–213PubMedGoogle Scholar
  20. 20.
    Otete EH, Ahankari AS, Jones H et al (2013) Parameters for the mathematical modelling of Clostridium difficile acquisition and transmission: a systematic review. PLoS ONE 8:e84224CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Drekonja DM, Amundson WH, Decarolis DD et al (1081) Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med 2011(124):e1081–e1087Google Scholar
  22. 22.
    Debast SB, Bauer MP, Kuijper EJ et al (2014) European society of clinical microbiology and infectious diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 20(Suppl 2):1–26CrossRefPubMedGoogle Scholar
  23. 23.
    Bagdasarian N, Rao K, Malani PN (2015) Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA 313:398–408CrossRefPubMedGoogle Scholar
  24. 24.
    Commisson MPA A Data Book: Medicare Part D Program, Washington, DC, Medicare Payment Advisory Commisson, 2010Google Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Charles M. Psoinos
    • 1
  • Courtney E. Collins
    • 1
  • M. Didem Ayturk
    • 1
  • Frederick A. Anderson
    • 1
    • 2
  • Heena P. Santry
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Department of Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations