OBJECTIVES

The objective of this research is to examine the efficacy of current antibiotic treatment regimens in preventing readmissions after hospital-acquired colostrum difficile (HA-CDIF) infections.

METHODS

The study cohort included adults hospitalized between January 2012 and January 2016 that developed HA-CDIF.HA-CDIF was defined using diagnosis codes 008.45(ICD-9) and A04.7x (ICD-10) and evidence of antibiotic treatment three or more days after hospital admission. Primary antibiotic treatment included vancomycin, metronidazole, fidaxomicin, and rifaximin as monotherapy or in combination. The effect of days to treatment start and treatment duration were also assessed. Logistic regression models were used to identify the probability of readmission with the specified timeframes

RESULTS

The patient population was predominately female (54.1%) with an average age of 66.5 years. Overall one year CDIF related readmission rate was 33.1%. Unadjusted 30 day readmission rates were significantly lower for patients initially treated with fidaxomicin/rifaximin regimens (10.3%) compared to vancomycin (18.1%) or metronidazole (17.5%) monotherapy and concomitant therapy (17.9% ; p < 0.05). After adjusting for patient and hospital characteristics, comorbidities, and treatment patterns females (OR=1.13; CI 1.04-1.24) were more likely to be readmitted than males. The presence of comorbidities such as acute myocardial infarction (OR=1.26; CI 1.10-1.44), heart failure (OR=1.19; CI 1.08-1.30), rheumatic conditions (OR=1.18; CI 1.08-1.30), malignancy (OR=1.35 CI 1.21-1.75), and severe liver disease (OR=1.68 CI 1.51-1.87) greatly increased likelihood of readmission. Initial antibiotic treatment regimen, time to antibiotic start, or treatment duration did not significantly increase or decrease likelihood of thirty day readmission for HA-CDIF patients.

CONCLUSIONS

This study demonstrates the need for additional treatment options for HA-CDIF as well as better protocols for management and prevention. With the Medicare payment reform reductions in both hospital acquired conditions and readmissions are increasingly important to hospitals.