Patients admitted from the community who are hospitalized with Clostridioides (formerly Clostridium) difficile infection were more frequently discharged to a non-home location compared to patients without C difficile infection, according to a study published in Clinical Infectious Diseases.
C difficile infection is associated with poor long-term patient outcomes posthospitalization, including decreased quality of life. Further, certain C difficile ribotypes are associated with increased disease severity and outcomes suggesting that certain ribotypes may be associated with increased risk for non-home discharge. Despite a high incidence of and mortality rate from C difficile infection in the United States, there have not been many studies focused on the transition of care for hospitalized patients with C difficile infection, specifically on the discharge disposition in patients originally admitted from community settings. This study assessed patient discharge dispositions to better understand risk factors for non-home discharge in patients with C difficile infection.
Researchers used a nationally representative database of patients in the Veterans Health Administration (2003-2014) and a validation group of hospitalized patients not in this database in Houston, Texas. Admission and discharge disposition was obtained for patients with C difficile infection and matched controls. A total of 15,173 patients in the Veterans Health Administration with C difficile infection and 48,599 patients who did not have C difficile infection (control patients) were included. Patients with C difficile infection were predominately older (median age 67 years), male (96%), and non-Hispanic white (66%). In addition, patients with C difficile infection more commonly had chronic comorbidities and recent or concomitant medication use compared to the control group. Incidence of and clinical/microbiologic risk factors for non-home discharge were assessed.
The most common discharge locations for patients with C difficile infection were community (78%), nursing home/long-term care facility (8%), hospice/death (12%), or other (2%). Significantly more patients with C difficile infection were discharged to a non-home location (18%) compared to controls (8% vs 3%; P <.0001), most commonly hospice/death (12% vs 3%; P <.0001) or nursing home/long-term care facility (6%). A total of 15% of patients with C difficile infection had a first recurrence, 45% of whom were re-hospitalized and 32% of whom had discharge disposition data available. These patients were most often admitted from the community (83%) for their recurrence. Compared to first episodes, the proportion of patients with C difficile infection discharged to a non-home setting was significantly lower for first recurrences (8%; P <.0001).
Results were confirmed using a propensity matched analysis and a validation cohort of 1941 patients hospitalized because of C difficile infection in Houston, Texas. Age greater than 65 years (P <.0001), congestive heart failure (P <.0001), severe C difficile infection (P =.04), and continued use of systemic antibiotics (P =.0022) were significant predictors of non-home discharge. Further, C difficile ribotypes F027 (P <.0001), F001 (P =.019), and F053-163 (P =.0005) were also associated with non-home discharge.
Overall, the study authors concluded that, “[T]hese findings also support routine strain type of C difficile isolates to identify patient populations at high risk for poor outcomes, including unfavorable discharge disposition, and additional studies identifying the most effective clinical treatment strategies for patients with high risk strain types.”
Reveles KR, Dotson KM, Gonzales-Luna A, Surati D, Endres BT, Alam MJ, Garey KW. Clostridioides (formerly Clostridium) difficile infection during hospitalization increases the likelihood of non-home patient discharge [published online September 11, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy782/5094866