Post-hospitalization Treatment Regimen and Readmission for C. difficile Colitis in Medicare Beneficiaries
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.
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.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.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
- 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.Bartlett JG (2002) Clinical practice. Antibiotic-associated diarrhea. New Engl J Med 346(334–33):9Google Scholar
- 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.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
- 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
- 16.Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36(8–2):7Google Scholar
- 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
- 24.Commisson MPA A Data Book: Medicare Part D Program, Washington, DC, Medicare Payment Advisory Commisson, 2010Google Scholar