216 Determinants of Hospital Admission in Patients With Community-Acquired Clostridium difficile Infection (CA-CDI)

Abstract

INTRODUCTION: Community-acquired Clostridium difficile infection (CA-CDI) is defined as Clostridium difficile infection (CDI) in patients who have not been in inpatient setting within 90 days of being tested positive for Clostridium difficile. The incidence of CA-CDI has been increasing in young individuals with no co-morbidities or recent antibiotic exposure. Recent research shows that up to 40% patients with CA-CDI need hospitalization, however, the risk factors associated with hospitalization of patients who test positive for CDI in outpatient setting has not been studied. The goal of this study is to look at patients diagnosed with CDI initially as outpatients and analyze the risk factors associated with hospitalization in these patients. METHODS: This study was approved by the Institutional Review Board. This is a retrospective chart review of 524 patients (189 males, 335 females, mean age 60 years) who were seen in the outpatient department from 2015 to 2018 and were tested for CDI. Inclusion criteria was patients over the age of 18 with positive C. difficile by nucleic acid amplification tests (NAATs). Exclusion criteria was prior diagnosis of C. difficile. For patients with positive C. difficile, the two outcomes selected were hospital admission within 2 weeks, and those remaining outpatients. The variables extracted from the electronic medical record included demographics, medications and co-morbidities. Utilizing a machine-learning algorithm, a Bayesian probabilistic predictive tool was constructed that evaluated a series of variables and their association with potential outcomes. RESULTS: Of the 524 patients that tested positive, 105 patients required admission within two weeks of diagnosis. The incidence of hospitalization among males and females was not significantly different. There was significant association between use of acid suppression medications (pantoprazole and famotidine) and risk of hospitalization for C. difficile (P-value <0.0001 and 0.002 for pantoprazole and famotidine, respectively). There was no association seen between co-morbidities such as coronary or carotid artery disease, peripheral vascular disease, diabetes mellitus and the risk of hospitalization. CONCLUSION: Although PPIs have been associated with increased risk of developing CDI, our study shows that acid suppression medications may also increase the risk of hospitalization for CDI. Providers should consider the risk versus benefit of continued use of acid suppression medications in patients with CDI.