Readmission Common Following CDI Hospitalization, Study Finds

About 1 in 5 people admitted to the hospital for Clostridioides difficile infection (CDI) in the United States end up back in the hospital within 1 month, and those who do face a higher risk of mortality, according to a new study.

This new report is based on nationwide readmission data from 2017 and was published in International Journal of Colorectal Disease.

The authors noted that about 15% of cases of health care–related infections are tied to CDI, and yet data about CDI readmission remain limited. Studies that do exist tend to be small in scope, be based on a single center, or have methodological problems, they wrote.

Explaining that they wanted to see what they could learn about CDI by using a large, nationally representative database of hospital readmissions, the investigators decided to consult the National Readmission Database, the largest data set of its kind. The database contains reports from nearly 2500 hospitals in 28 states, and the data are de-identified to protect patient privacy.

The investigators used International Classification of Diseases, 10th Revision, Clinical Modification codes to find patients admitted to the hospital for CDI. Those patients were then tracked for 30- and 90-day readmissions. In addition to those primary outcomes, the secondary outcomes were mortality rates and health care consumption.

The authors found 83,865 patients who were discharged from the hospital after being hospitalized with a primary diagnosis of CDI. Within 30 days of discharge, 22.37% of patients were back in the hospital, and by the 90-day mark, another 15.01% had been readmitted. In 30% of those cases, the cause of readmission was recurrent CDI.

The authors found certain factors decreased a patient’s likelihood of readmission.

“Age greater than 60 years and private insurance were found to be protective factors for readmission at both 30 and 90 days, with female gender being an additional protective factor for readmission at 30 days,” they wrote.

The fact that older patients had a smaller chance of being readmitted is likely not related to biological factors, the investigators said, but rather because older patients are more likely to receive home health care. The lower readmission rate could also be caused by patients dying outside of the hospital, an event that would not be reflected in these data.

When patients were readmitted, the authors found they had a greater risk of dying in the hospital and were more likely to have higher health care costs. For instance, during the initial hospitalization, the mortality rate was just 1.41%; however, for those readmitted within 30 days, the mortality rate was 4.86%, and within 90 days, 4.40%. Readmitted patients also had longer hospital stays and higher health care charges.

The investigators concluded that physicians must be vigilant with patients admitted to the hospital for CDI in order to reduce the likelihood of readmission and of mortality.

“[W]e would suggest more expedient care for those hospitalized for recurrent CDI based upon this finding,” they wrote, adding that particular attention should be paid to patients at higher risk of readmission. “This information may facilitate the recognition of high-risk patients, optimize the distribution of resources, and ultimately result in lower mortality and health care consumption among patients with CDI.”

Reference

Sharma S, Weissman S, Walradt T, et al. Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study. Int J Colorectal Dis. Published online August 7, 2021. doi:10.1007/s00384-021-04001-w