Impact Of Clostridium Difficile Infection Research Articles

Impact of clostridium difficile infection on mortality among gastrointestinal (GI) and lung cancers.

e18735Background: Clostridium Difficile Infection (CDI) resulted in almost half a million cases, 83,000 re-infections and 29,000 deaths in 2011. Limited studies have shown increased incidence of CD...

Impact of clostridium difficile infection on short-term outcomes in hospitalized patients with hematologic malignancies: A national sample.

e18711Background: Patients with hematologic malignancies are susceptible to clostridium difficile infection (CDI) given their exposure to chemotherapy and subsequent development of neutropenia. Thi...

Issue Highlights

Issue Highlights

The Epidemiology of Clostridium difficile Infection in Japan: A Systematic Review.

To increase understanding of the epidemiology, risks, consequences and resource utilization of Clostridium difficile infection (CDI) in Japan, a systematic literature review was undertaken of relevant publications from January 2006 to November 2017. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and methods, 55 articles met the criteria for full review. The majority (58%) of studies were from a single site, with the most recent data from 2015. The incidence, reported prevalence and recurrence rate of CDI in Japan were 0.8–4.71/10,000 patient-days, 0.3–5.5/1000 patients and 3.3–27.3%, respectively, and varied according to setting, population, CDI definition and detection method. Most C. difficile isolates associated with CDI in Japan were toxin A+B+, with a low level of C. difficile binary toxin-positive (CDT+) strains (0–6.8% reported across studies). The most common C. difficile PCR ribotypes associated with infection in Japan were smz/018, 002, 052 and 369. Data regarding the impact of CDI on length of hospital stay were limited. Reported all-cause mortality in patients with CDI ranged from 3.4 to 15.1% between 2007 and 2013. Two studies assessed risk factors for CDI recurrence, identifying malignant disease, intensive care unit hospitalization and use of proton pump inhibitors as factors increasing the risk of initial and/or recurrent CDI. No study analyzed initial CDI treatment in relation to recurrence. More comprehensive surveillance and coordinated studies are needed to map trends, understand risk factors, and recognize the extent and impact of CDI in Japanese patients.FundingAstellas Pharma, Inc.Plain Language SummaryPlain language summary available for this article.Electronic supplementary materialThe online version of this article (10.1007/s40121-018-0186-1) contains supplementary material, which is available to authorized users.

The Impact of Clostridium difficile Infection on Mortality in Patients With Inflammatory Bowel Disease

The Impact of Clostridium difficile Infection on Mortality in Patients With Inflammatory Bowel Disease

Lasting Impact of Clostridium difficile Infection in Inflammatory Bowel Disease: A Propensity Score Matched Analysis.

Patients with inflammatory bowel disease are at an increased risk of Clostridium difficile infection (CDI), but the impact of CDI on disease severity is unclear. The aim of this study was to determine the effect of CDI on long-term disease outcome in a matched cohort of patients with inflammatory bowel disease. Patients who tested positive for infection formed the CDI-positive group. We generated a 1:2 propensity matched case to control cohort based on risk factors for CDI in the year before infection. Health care utilization data (emergency department use, hospitalizations, and telephone encounters), medications, laboratories, disease activity, and quality-of-life metrics were compared by CDI status. A total of 198 patients (66 CDI and 132 matched controls) were included (56.6% women; 60.1% Crohn's disease, and 39.9% ulcerative colitis). In the year of infection, having CDI was significantly associated with more steroid and antibiotic exposure, elevated C-reactive protein or erythrocyte sedimentation rate, low vitamin D, increased disease activity, worse quality of life, and increased health care utilization (all P < 0.01). During the next year after infection, patients with CDI continued to have increased exposure to CDI-targeted antibiotics (P < 0.001) and other antibiotics (P = 0.02). They also continued to have more clinic visits (P = 0.02), telephone encounters (P = 0.001), and increased health care financial charges (P = 0.001). CDI in inflammatory bowel disease is significantly associated with markers of disease severity, increased health care utilization and poor quality of life during the year of infection, and a 5-fold increase in health care charges in the year after infection (see Video Abstract, Supplemental Digital Content, http://links.lww.com/IBD/B658).

Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center

ObjectivesTo describe the clinical characteristics, outcomes, and factors associated with Clostridium difficile infection (CDI) due to ribotype 027 (RT027) and recurrence, including an outbreak period, with transition to endemicity. MethodsA case–control study was performed. Clinical and demographic data were collected for patients with CDI during the period January 2008 to December 2015. Ribotyping of the isolates and PCR for toxin A, B, and binary were performed. ResultsAmong 324 episodes of CDI, 27.7% were caused by RT027. Previous fluoroquinolone use (odds ratio (OR) 1.79, 95% confidence interval (CI) 1.01–3.17), previous gastrointestinal endoscopy (OR 2.17, 95% CI 1.29–3.65), chemotherapy (OR 0.43, 95% CI 0.19–0.95), and total enteral nutrition (OR 0.42, 95% CI 0.18–0.97) were associated with RT027. Age >65 years (OR 2.05, 95% CI 1.02–4.10), severe initial episode (OR 3.35, 95% CI 1.60–6.15), previous proton pump inhibitor use (OR 2.34, 95% CI 1.15–4.74), and continued fluoroquinolones (OR 3.08, 95% CI 1.11–8.51) were associated with recurrence. Among the non-RT027, 59.8% were not assigned by the ribotyping database and 50.7% presented binary toxin. ConclusionsIn this population, CDI due to the RT027 strain was not associated with poorer outcomes. This study reinforces the importance of avoiding fluoroquinolones and PPIs to prevent recurrences. The presence of virulence factors among non-RT027 C. difficile strains underscores the importance of performing molecular epidemiology surveillance.

Impact of Clostridium difficile Infection on Patients’ Quality of Life: a French Hospital Prospective Study

BackgroundFew data are available on the impact of episodes of Clostridium difficile infection (CDI) on quality of life. The Cdiff32, a new specific health-related quality of life questionnaire recently validated, allows such a measurement (Garey et al. J Clin Gastroenterol 2016 Sep;50(8):631–7).MethodsAn observational prospective study was performed in 7 French acute-care facilities in 2016. All consecutive patients presenting with a bacteriologically-confirmed CDI during a hospital stay, regardless of reason for hospitalization, were enrolled. Two instruments were presented to patients at 7(±2) days after CDI diagnosis: the Cdiff32 and a generic questionnaire the EQ-5D-3L. The Cdiff32 comprises 32 self-administered questions about the impact of CDI in 3 broad domains (physical, mental and social). The physical domain differentiates general (6 questions) and specific physical complaints (8 questions). The mental domain comprises 14 questions about current and future anxiety. Four questions cover the impact on social relationships. Each item is scored from 0 (worst score) to 100 (best score) and they are aggregated by domain and globally. Clinical variables were collected to characterize the infection severity (ZAR score) and comorbidities. A regression analysis of the Cdiff32 scores with the EQ-5D-3L was performed.Results80 patients were enrolled and 3 were excluded because of missing data. The median age was 71 years and 45% were males. The global Cdiff32 score was 50.4 (SD: 17.1) with a large variability among patients (min 18.3, max 90.2). The highest impact of CDI was observed on the general physical complaints (41.6), as well as the level of current anxiety (41.6). The score relating to the social relationships was the highest (63.7). The severity of CDI (as defined by the Zar score) and the global Cdiff32 score were correlated essentially through the physical sub-score (P = 0.0154). Patients with recurrences had a lower mental score compared with patients with an initial episode (P = 0.0582). The regression analysis of global Cdiff32 score and EQ-5D-3L utility score showed a positive relationship (R2=0.317).ConclusionThe Cdiff32 allowed to estimate the important impact on quality of life of CDI especially on the physical domain.Disclosures All authors: No reported disclosures.

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OBJECTIVES/SPECIFIC AIMS: Inflammatory bowel disease (IBD) patients are at an increased risk of Clostridium difficile infection (CDI) but the impact of CDI on disease severity is unclear. The aim of this study was to determine the effect of CDI on long-term disease outcome in a cohort of IBD patients. METHODS/STUDY POPULATION: We analyzed patients enrolled in a prospective IBD natural history registry. Patients who tested positive at least once formed the CDI positive group. We generated a 2:1 propensity matched control cohort based on risk factors of CDI in the year before infection. Healthcare utilization data (emergency department use, subsequent hospitalizations, telephone encounters), medications, labs, disease activity, and quality of life metrics were temporally organized. RESULTS/ANTICIPATED RESULTS: A total of 198 patients (66 CDI, 132 matched controls) were included [56.6% female; 60.1% Crohn’s disease (CD), 39.9% ulcerative colitis (UC)]. Groups were not significantly different in the year before infection in all metrics but in the year of infection, having CDI was significantly associated with more steroid and antibiotic exposure, elevated C-reactive protein or erythrocyte sedimentation rate, and low vitamin D (all p&lt;0.01). Infection was associated with increased disease activity metrics (UC: p=0.036, CD: p=0.003), worse disease-related quality of life (p=0.003), and increased healthcare utilization (p&lt;0.001). In the next year after infection those with prior CDI continued to have increased exposure to vancomycin or fidaxomicin (p&lt;0.001) and all other antibiotics (p=0.01). They also continued to have more clinic visits (p=0.006), telephone encounters (p=0.001), and worse disease-related quality of life (p=0.03), but disease activity and biomarkers of severity were not significantly different between groups. DISCUSSION/SIGNIFICANCE OF IMPACT: CDI infection in IBD is significantly associated with various surrogate markers of disease severity, increased healthcare utilization and poor quality of life during the year of infection. CDI patients continue to experience poor quality of life after infection with increased clinic visits and antibiotic exposure while disease activity is no longer significantly increased. These findings suggest that CDI infection may have a lasting effect on healthcare utilization beyond the acute treatment period.

Excess mortality between 2007 and 2014 among patients with Clostridium difficile infection: a French health insurance database analysis

The impact of Clostridium difficile infection (CDI) on mortality is controversial. To assess excess mortality due to CDI in France. Two cohorts of patients with CDI and a cohort of matched controls were extracted from a 1% representative sample of subjects covered by the general health insurance system in France (Echantillon Généraliste de Bénéficiaires database, 660,000 patients). The CDI patients were hospitalized with CDI as a principal diagnosis or an associated diagnosis between 2007 and 2014, but not in 2006. Controls were patients hospitalized between 2007 and 2014 but not hospitalized with CDI between 2006 and 2014. The one-year incidence of deaths between 2007 and 2014 was estimated and compared with that of a propensity score (PS)-matched control group with no CDI (two controls per case). The PS was calculated with the following variables: age; sex; Charlson Comorbidity Index score; duration of stay; year of index stay; and main comorbidities. Cox and Poisson models were used to estimate the increased risk of death while adjusting for PS. Sensitivity analyses (timeframe, diarrhoea, recurrent hospitalization for CDI) were used to explore the robustness of the results. In total, 482 patients who had been infected with C.difficile were matched with 964 controls. A significantly higher risk of death was observed among the subjects with CDI, with a non-adjusted hazard ratio of 1.65 [95% confidence interval (CI) 1.33-2.04] and an adjusted ratio of 1.58 (95% CI 1.27-1.97). The adjusted relative risk of death was 1.78 (95% CI 1.18-2.70]) at 28 days, 1.52 (95% CI 1.17-1.98) at three months, 1.52 (95% CI 1.20-1.93) at six months and 1.64 (95% CI 1.32-2.03) at 12 months. Sensitivity analyses produced similar results; the hazard ratio ranged from 1.53 to 1.86, and was always statistically significant. CDI is responsible for excess mortality after taking age, sex, comorbidities and length of hospital stay into account.

Trends in the Incidence and Outcomes of Hospitalized Cancer Patients With Clostridium difficile Infection: A Nationwide Analysis.

Background: Patients with cancer have several risk factors for Clostridium difficile infection (CDI), but the impact of CDI on outcomes in this population needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in patients with cancer using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010. Methods: Diagnosis codes were used to identify patients with cancer and CDI events. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study CDI incidence and CDI-associated outcomes. Analyses were performed using SAS version 9.4. Results: During the 10-year study period, 20.1 million discharges had a cancer diagnosis. CDI developed in 1.09% of patients with cancer versus 0.77% of patients without cancer (adjusted odds ratio [aOR], 1.28; 95% CI, 1.28-1.29; P<.001). The incidence of CDI in patients with cancer increased during the 10-year study period (64.7 per 10,000 discharges in 2001-2002 to 109.1 in 2009-2010; P<.001). In multivariable analysis, compared with patients with cancer without CDI, patients with cancer and CDI had a longer mean LOS (5.67 days; 95% CI, 5.39-5.94) and higher rates of in-hospital mortality (aOR, 1.18; 95% CI, 1.16-1.20) and discharge to a care facility (aOR, 1.74; 95% CI, 1.72-1.75; all P<.001). Conclusions: In this national database, CDI incidence increased significantly in patients with cancer over the study period and was associated with prolonged hospitalization, increased mortality, and discharge to a care facility. Despite increased attention, CDI remained a serious infection and merits appropriate prevention and management.

The cost of Clostridium difficile infection (CDI) in hospital in Italy

Objective To describe characteristics, resource utilization and cost for patients experiencing a primary episode of CDI and recurrent CDI. Methods A retrospective observational cohort study was conducted. CDI data were collected with an electronic case report form (CRF) from five Hospitals in Italy. Hospitals collected all resource use attributable to CDI during the period 2011-2014. All resource use from initial presentation to the healthcare provider for CDI symptoms, until resolution of infection attributable to CDI in each enrolled patient was included. The patient cohort was analysed both as a whole and in stratified subgroups (by age, gender and co-morbidities). The impact of CDI on hospital length of stay (LOS) was used to calculate CDI-attributable costs. The total cost of a CDI episode was estimated by multiplying each resource used by its unit cost (national tariffs and market prices); finally, the mean cost/patient was calculated across the cohort. Results In total, data were collected for 488 adult infected patients (mean age 76.0 years [SD ± 15.48]; female 56.6%). Five hundred and three (503) episodes were evaluated (mean number per patient: 1.03 [SD ± 0.23]). LOS attributable to CDI was 14.6 days (SD ± 13.14). Attributable cost per adult patient was €10,224.08 (SD ± €8,963.86), with the majority of the cost being due to hospitalization. The mean cost of a recurrent episode of CDI was €9,504.87 [SD ± €8,614.11]. Conclusions These findings show that the economic burden of CDI is considerable in Italy. The most important cost driver was the LOS attributable to CDI.

Systematic review with meta-analysis: the impact of Clostridium difficile infection on the short- and long-term risks of colectomy in inflammatory bowel disease.

Clostridium difficile infection (CDI) is associated with increased mortality in inflammatory bowel disease (IBD), but the risk of colectomy is variable and has not been adequately studied. To perform a systematic review and meta-analysis to assess the impact ofCDI on colectomy risk in IBD. Multiple databases were searched systematically for observational studies reporting colectomy risk in IBD, stratified by the presence of CDI, and the duration of follow-up (short term 3months, and long term at least 1year). Weighted summary estimates were calculated using generalised inverse variance with random-effects model. Study quality was assessed using the Newcastle-Ottawa scale. Twelve observational studies were identified and included 35057 IBD patients with CDI, and 929259 without CDI. CDI did not increase the short-term colectomy risk in IBD patients overall (10 studies) (OR: 1.35; 95% CI: 0.68-2.67), or in patients with ulcerative colitis (nine studies) (OR: 1.20; 95% CI: 0.39-3.76). In contrast, CDI was associated with higher long-term colectomy risk in patients with IBD overall (five studies) (OR: 2.23; 95% CI: 1.18-4.21), and in patients with ulcerative colitis (four studies) (OR: 2.96; 95% CI: 1.19-7.34). The results were stable in subgroups stratified by recruitment period, hospitalisation status and geographical location. All studies were at least of moderate quality. The results were limited in the ability to compare IBD severity and the type of anti-microbial therapy. Based on 12 observational studies with at least moderate quality, Clostridium difficile infection appears to increase colectomy risk in IBD in the long- but not short- term.

Incidence and outcomes of hospitalized patients with gastrointestinal malignancies and Clostridium difficile infection: A nationwide analysis.

704 Background: Inpatients with gastrointestinal (GI) malignancies are at a high risk for Clostridium difficile infection (CDI) but the impact of CDI on outcomes in these patients needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in GI cancer patients using the National Hospital Discharge Survey (NHDS) database from 2001 - 2010. Methods: NHDS collects clinical information on patients dismissed from non-Federal short-stay United States hospitals. Demographics, diagnoses (GI malignancies, CDI and comorbidities), length of stay (LOS), and dismissal information were abstracted using ICD-9 diagnosis and procedure codes. Weighted analyses were performed using SAS version 9.4. Results: Of an estimated 317.9 million unique hospitalizations; 4.6 million had a diagnosis of a GI malignancy (1.4%); median age 68 years, 46.1% female. CDI was more common in patients with GI malignancies compared to patients with no GI malignancy (1.05% vs 0.69%, aOR 1.16, 95% CI 1.15- 1.17, p &lt; 0.0001). There was a significant increase in CDI incidence in GI cancer patients over the 10-year study period (72.7 in 2001-2002 to 109.1 in 2009-2010, per 10,000 discharges, p &lt; 0001). In multivariable analysis, compared to GI cancer patients without CDI, GI cancer patients with CDI had a longer mean LOS (3.94 more days, 95% CI 3.31-4.56) and dismissal to a care facility (adjusted OR, 1.75; 95% CI, 1.71-1.79), but lower all-cause in-hospital mortality (adjusted OR, 0.76; 95% CI, 0.74-0.79), all p &lt; 0.0001 Conclusions: In this national database of hospitalized patients, an increasing incidence of CDI in patients with GI malignancies was noted over the study period. CDI prolonged hospitalization, and was associated with increased dismissal to a care-facility. Lower rates of in-hospital mortality may represent early diagnosis due to vigilance or a milder form of CDI. Despite increased attention over the last few decades, CDI remained a serious infection in GI cancer patients, and merits appropriate prevention, management and follow-up.

Cost analysis of an outbreak of Clostridium difficile infection ribotype 027 in a Dutch tertiary care centre

The economic impact of Clostridium difficile infection (CDI) on the healthcare system is significant. From May 2013 to May 2014, an outbreak of C.difficile ribotype 027 occurred in a Dutch tertiary care hospital, involving 72 patients. The primary aim of this study was to provide insight into the financial burden that this CDI outbreak brought upon this hospital. A retrospective analysis was performed to estimate the costs of a one-year-long C.difficile ribotype 027 outbreak. Medical charts were reviewed for patient data. In addition, all costs associated with the outbreak control measures were collected. The attributable costs of the whole outbreak were estimated to be €1,222,376. The main contributing factor was missed revenue due to increased length of stay of CDI patients and closure of beds to enable contact isolation of CDI patients (36%). A second important cost component was extra surveillance and activities of the Department of Medical Microbiology and Infection Control (25%). To the authors' knowledge, this is the first study to provide insight into the attributable costs of CDI in an outbreak setting, and to delineate the major cost items. It is clear that the economic consequences of CDI are significant. The high costs associated with a CDI outbreak should help to justify the use of additional resources for CDI prevention and control.

Clostridium difficile in an Urban, University-Affiliated Long-Term Acute-Care Hospital.

OBJECTIVES To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH). DESIGN Retrospective matched cohort study. SETTING A 38-bed, urban, university-affiliated LTACH. METHODS The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL. A conditional Poisson regression model was developed to determine characteristics associated with a composite primary outcome of 30-day readmission to an acute-care hospital, or mortality. RESULTS The overall incidence of CDI was 21.4 cases per 10,000 patient days, with 27% of infections classified as severe. Patients with CDI had a mean age of 70 years (SD, 14 years), a mean Charlson comorbidity index of 3.6 (SD, 2.0), a median length of stay of 33 days (interquartile range [IQR], 24-45 days), and a median time between admission and CDI diagnosis of 16 days (IQR, 9-23 days). The most commonly prescribed antibiotic preceding a CDI diagnosis was a cephalosporin, with median duration of 8 days (IQR, 4-14 days). In multivariate analysis, CDI was not significantly associated with the primary outcome (relative risk, 0.97; 95% CI, 0.59-1.58). CONCLUSIONS Incidence of CDI in an urban, university-affiliated LTACH was high. Future research should focus on infection prevention measures to decrease the burden of CDI in this complex patient population. Infect Control Hosp Epidemiol 2017;38:294-299.

Clostridium difficile in an Urban, University-Affiliated Long-Term Acute Care Hospital

OBJECTIVES To describe the characteristics and impact of Clostridium difficile infection (CDI) in a long-term acute-care hospital (LTACH). DESIGN Retrospective matched cohort study. SETTING A 38-bed, urban, university-affiliated LTACH. METHODS The characteristics of LTACH-onset CDI were assessed among patients hospitalized between July 2008 and October 2015. Patients with CDI were matched to concurrently hospitalized patients without a diagnosis of CDI. Severe CDI was defined as CDI with 2 or more of the following criteria: age ≥65 years, serum creatinine ≥2 mg/dL, or peripheral leukocyte count ≥20,000 cells/μL. A conditional Poisson regression model was developed to determine characteristics associated with a composite primary outcome of 30-day readmission to an acute-care hospital, or mortality. RESULTS The overall incidence of CDI was 21.4 cases per 10,000 patient days, with 27% of infections classified as severe. Patients with CDI had a mean age of 70 years (SD, 14 years), a mean Charlson comorbidity index of 3.6 (SD, 2.0), a median length of stay of 33 days (interquartile range [IQR], 24–45 days), and a median time between admission and CDI diagnosis of 16 days (IQR, 9–23 days). The most commonly prescribed antibiotic preceding a CDI diagnosis was a cephalosporin, with median duration of 8 days (IQR, 4–14 days). In multivariate analysis, CDI was not significantly associated with the primary outcome (relative risk, 0.97; 95% CI, 0.59–1.58). CONCLUSIONS Incidence of CDI in an urban, university-affiliated LTACH was high. Future research should focus on infection prevention measures to decrease the burden of CDI in this complex patient population. Infect Control Hosp Epidemiol 2017;38:294–299

Diverticular Disease Is Associated with Increased Colectomy Rates and Total Hospitalization Charges in Patients with Clostridium difficile Infection: Results of a Nationwide Analysis

Introduction:Clostridium difficile infection (CDI) has been associated with increased resource utilization and morbidity in many conditions, from ulcerative colitis to cirrhosis. To date, studies have only evaluated the relationship between diverticular disease (DD) and CDI relapse. However, the impact of CDI on outcomes of patients with DD has not been explored, for the aim of this study was to do so using a national database. Methods: This was a retrospective cohort study using the 2013 National Inpatient Sample, the largest publically available inpatient database in the US. All patients with a principal ICD-9 CM diagnosis code for CDI were included in the study. There were no exclusion criteria. The primary outcome was inhospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, need for colectomy, shock and multi-organ failure; resource utilization measured by colonoscopy, abdominal CT scan, abdominal ultrasound (US), total parenteral nutrition (TPN) use, length of hospital stay (LOS) and total hospitalization charges. Patients were classified as having or not having DD using ICD-9 CM codes. Using multivariate regression analysis, odds ratios and means were adjusted for presence of diabetes, age, sex, race, median income in the patient's zip code, Charlson Comorbidity Index, hospital region, urban location, size and teaching status. Results: 166,250 patients with CDI were included in the study, 1,355 (0.8%) of whom had DD. Mean age was 65 years and 63% were female. The overall in-hospital mortality rate was 2.5% (0.4% in the DD subgroup). Table 1 shows all adjusted odds ratios, means and p values. On multivariate analysis, patients with and without diverticular disease did differ in odds of mortality (OR:0.18, 95%CI:0.02-1.33, p=0.10). Looking at morbidity, patients with DD displayed markedly higher odds of colectomy when compared with patients without DD. For resource utilization, patients with DD had higher odds of colonoscopy and abdominal CT scan use. Further, total charges were higher for patients with DD, while LOS was similar between the two groups.Table 1: Adjusted means and odds ratios for evaluated parameters in patients with CDI that had DD compared to patients without DD.Conclusion: Diverticular disease is not associated with increased mortality in patients with CDI. However, DD affects resource utilization to different degrees, as measured by increased odds of colonoscopy, abdominal CT use, and total hospitalization charges. Diverticular disease is associated with increased odds of colectomy.

Clostridium difficile: A healthcare-associated infection of unknown significance in adults in sub-Saharan Africa.

Clostridium difficile infection (CDI) causes a high burden of disease in high-resource healthcare systems, with significant morbidity, mortality, and financial implications. CDI is a healthcare-associated infection for which the primary risk factor is antibiotic usage, and it is the leading cause of bacterial diarrhoea in HIV-infected patients in the United States. Little is known about the disease burden of CDI in sub-Saharan Africa, where HIV and healthcare-associated infections are more prevalent and antibiotic usage is less restricted. This article reviews published literature on CDI in sub-Saharan Africa, highlighting areas for future research. English language publications since 1995 were identified from online databases (PubMed, Medline, Google Scholar, and SCOPUS), using combinations of keywords "C. difficile", "Africa", and "HIV". Ten relevant studies were identified. There was considerable variation in the methodologies used to assess for carriage of toxigenic C. difficile and its associations. Eight studies reported carriage of toxigenic C. difficile. Three (of three) studies found an association with antibiotic usage. One (of four) studies showed an association with HIV infection. One study showed no association with degree of immunosuppression in HIV. Two (of three) studies showed an association between carriage of toxigenic C. difficile and diarrhoeal illness. While the carriage of toxigenic C. difficile is well described in sub-Saharan Africa, the impact of CDI in the region remains poorly understood and warrants further research.

Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011: A nationwide study.

The elderly population is particularly vulnerable to Clostridium difficile infection (CDI), but the epidemiology of CDI in long-term care facilities (LTCFs) is unknown.We performed a retrospective cohort study and used US 2011 LTCF resident data from the Minimum Data Set 3.0 linked to Medicare claims. We extracted CDI cases based on International Classification of Diseases-9 coding, and compared residents with the diagnosis of CDI to those who did not have a CDI diagnosis during their LTCF stay. We estimated CDI prevalence rates and calculated 3-month mortality rates.The study population consisted of 2,190,613 admissions (median age 82 years; interquartile range 76-88; female to male ratio 2:1; >80% whites), 45,500 of whom had a CDI diagnosis. The nationwide CDI prevalence rate was 1.85 per 100 LTCF admissions (95% confidence interval [CI] 1.83-1.87). The CDI rate was lower in the South (1.54%; 95% CI 1.51-1.57) and higher in the Northeast (2.29%; 95% CI 2.25-2.33). Older age, white race, presence of a feeding tube, unhealed pressure ulcers, end-stage renal disease, cirrhosis, bowel incontinence, prior tracheostomy, chemotherapy, and chronic obstructive pulmonary disease were independently related to "high risk" for CDI. Residents with a CDI diagnosis were more likely to be admitted to an acute care hospital (40% vs 31%, P < 0.001) and less likely to be discharged to the community (46% vs 54%, P < 0.001) than those not reported with CDI during stay. Importantly, CDI was associated with higher mortality (24.7% vs 18.1%, P = 0.001).CDI is common among the elderly residents of LTCFs and is associated with significant increase in 3-month mortality. The prevalence is higher in the Northeast and risk stratification can be used in CDI prevention policies.