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Objective
To examine the epidemiology and outcomes of Medicare beneficiaries admitted with community acquired C. difficile infections.
Design
Retrospective review of national administrative database(Medicare)
Setting
5% random sample of Medicare claims data (2009-2010) including inpatient, outpatient, and Part D (outpatient prescription drug claims) data.
Patients or Other Participants
C.difficile cases were defined as any hospital admission with a primary ICD-9 diagnosis code=08.45. Cases were limited to community-acquired C.difficile (CACD) infections by including only the first C.difficile admission and excluding patients hospitalized OR receiving IV/IM antibiotics in the 90 days prior to admission.
Main Outcome Measures
We determined the rate of CACD, patient characteristics (age, co-morbidities, sex, race), pre-admission antibiotic exposure (<30 days, 31-60 days, 61-90 days) and C.difficile treatment, inpatient outcomes (colectomy, ICU stay, length of stay, mortality), and subsequent admissions for C.difficile.
Results:
2049 (0.25%) patients were admitted with C. difficile, 1061 (52%) with CACD. 50% of CACD patients received oral antibiotics within 90 days of admission: <31dys=39%, 31-60dys=8%, and 61- 90dys=3.7%. Few were treated pre-admission with oral Metronidazole (4.5%) or Vancomycin (0.7%).13% of patients required ICU admission with a median ICU-LOS of 4 (IQR 6). Few(1.3%) underwent colectomy. Hospital mortality was 10.8%. Median overall LOS was 5 days (IQR 5). 20% of survivors were re-admitted with C.difficile within one year of discharge.
Conclusions:
Half of Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and re-admission rates suggest that the burden of C.difficile on patients and the healthcare system will be significant as the US population ages if the virulence of CACD continues to increase.