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Purpose: Hospitalization is one of the strongest drivers of healthcare costs. Recurrent Clostridium difficile infection (rCDI) is common and patients with rCDI are frequently rehospitalized. It is hypothesized that rCDI is an independent risk factor for a rehospitalization.
Methods: This is a retrospective cohort study of all adult patients with an initial case of CDI (iCDI) at Barnes-Jewish Hospital (BJH) from 1/1/03 to 12/31/09. The observation period for rehospitalization was 180 days from the rCDI or end of the risk period for rCDI. An iCDI episode was defined as a positive toxin assay for C. difficile with no CDI in the previous 60 days. rCDI was defined as symptomatic patients with repeat positive toxin within 42 days of stopping the iCDI treatment. Patients with ≥1 rehospitalization were compared to those not rehospitalized based on their demographic characteristics, rCDI status, comorbidities, laboratory data and treatment exposures. A generalized linear model was developed to estimate the impact of rCDI on the risk of a rehospitalization.
Results: Among the 3,601 patients with iCDI, 1471 (41%) were rehospitalized. Of the 432 patients with rCDI, 362 (84%) were rehospitalized. Independent risk factors for rehospitalization on multivariate analysis included rCDI (relative risk [RR]=2.15, 95% confidence interval [CI]=2.01-2.30), non-white race (RR=1.13, 95%CI=1.04-1.22), prior admissions to the hospital before iCDI (RR=1.24, 95%CI=1.15-1.34), receipt of >10 days of vancomycin (RR=1.10, 95%CI=1.00-1.24), a receipt of 5-10 days low-CDI risk antibiotics (RR=1.14, 95%CI=1.01-1.28), receipt of >10d low CDI risk antibiotics (marker for severity-of-illness) (RR=1.13, 95%CI=1.01-1.27), and 11 comorbidities (range of RR=1.17-1.55). Age ≥70, not receiving a fluoroquinolone or low-CDI risk antibiotic, and an elevated WBC at time of iCDI were protective against rehospitalization. Age ≥70 likely appeared protective due to competing risk of death.
Conclusion: rCDI was the risk factor most strongly associated with rehospitalization.