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

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Abstract

Background

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.

Results

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.

Conclusions

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.

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Funding

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.

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Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Medical School, Room S3-731, 55 Lake Avenue North, Worcester, MA, 01655, USA

    Charles M. Psoinos, Courtney E. Collins, M. Didem Ayturk, Frederick A. Anderson & Heena P. Santry

  2. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Frederick A. Anderson & Heena P. Santry

Authors
  1. Charles M. Psoinos
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  2. Courtney E. Collins
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  3. M. Didem Ayturk
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  4. Frederick A. Anderson
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  5. Heena P. Santry
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Corresponding author

Correspondence to Heena P. Santry.

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Psoinos, C.M., Collins, C.E., Ayturk, M.D. et al. Post-hospitalization Treatment Regimen and Readmission for C. difficile Colitis in Medicare Beneficiaries. World J Surg 42, 246–253 (2018). https://doi.org/10.1007/s00268-017-4139-8

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  • DOI: https://doi.org/10.1007/s00268-017-4139-8

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