Estimating the Attributable Disease Burden and Effects of Interhospital Patient Sharing on Clostridium difficile Infections

2019 ◽  
Vol 40 (6) ◽  
pp. 656-661 ◽  
Author(s):  
Daniel K. Sewell ◽  
Jacob E. Simmering ◽  
Samuel Justice ◽  
Sriram V. Pemmaraju ◽  
Alberto M. Segre ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Disease Burden ◽  
Local Level ◽  
Intervention Strategies ◽  
Directed Network ◽  
Patient Transfers ◽  
Network Autocorrelation ◽  
Monthly Average ◽  
Number Of Patients ◽  
Inpatient Database

AbstractObjective:To estimate the burden of Clostridium difficile infections (CDIs) due to interfacility patient sharing at regional and hospital levels.Design:Retrospective observational study.Methods:We used data from the Healthcare Cost and Utilization Project California State Inpatient Database (2005–2011) to identify 26,878,498 admissions and 532,925 patient transfers. We constructed a weighted, directed network among the hospitals by defining an edge between 2 hospitals to be the monthly average number of patients discharged from one hospital and admitted to another on the same day. We then used a network autocorrelation model to study the effect of the patient sharing network on the monthly average number of CDI cases per hospital, and we estimated the proportion of CDI cases attributable to the network.Results:We found that 13% (95% confidence interval [CI], 7.6%–18%) of CDI cases were due to diffusion through the patient-sharing network. The network autocorrelation parameter was estimated at 5.0 (95% CI, 3.0–6.9). An increase in the number of patients transferred into and/or an increased CDI rate at the hospitals from which those patients originated led to an increase in the number of CDIs in the receiving hospital.Conclusions:A minority but substantial burden of CDI infections are attributable to hospital transfers. A hospital’s infection control may thus be nontrivially influenced by its neighboring hospitals. This work adds to the growing body of evidence that intervention strategies designed to minimize HAIs should be done at the regional rather than local level.

Attributable Cost of Clostridium difficile Infection in Pediatric Patients

2017 ◽  
Vol 38 (12) ◽  
pp. 1472-1477 ◽  
Author(s):  
Preeti Mehrotra ◽  
Jisun Jang ◽  
Courtney Gidengil ◽  
Thomas J. Sandora
Keyword(s):  
Logistic Regression ◽  
Clostridium Difficile ◽  
Propensity Score ◽  
Regression Model ◽  
Generalized Linear Model ◽  
Logistic Regression Model ◽  
Propensity Scores ◽  
Healthcare Research ◽  
Design And Methods ◽  
Inpatient Database

OBJECTIVESThe attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children.DESIGN AND METHODSWe analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score–matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost.RESULTSWe identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days.CONCLUSIONSClostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost.Infect Control Hosp Epidemiol 2017;38:1472–1477

Resource access mechanisms in networks and SME survival in Ghana

2018 ◽  
Vol 12 (5) ◽  
pp. 611-631 ◽  
Author(s):  
George Acheampong ◽  
Raphael Odoom ◽  
Thomas Anning-Dorson ◽  
Patrick Amfo Anim
Keyword(s):  
Census Data ◽  
Local Level ◽  
Directed Network ◽  
Resource Access ◽  
Content Type ◽  
Structural Hole ◽  
One Year ◽  
Global And Local ◽  
Access Mechanisms ◽  
Global Influence

Purpose The study aims to determine the resource access mechanism in inter-firm networks that aids SME survival in Ghana. Design/methodology/approach The authors collect census data on a poultry cluster in Ghana and construct a directed network. The network is used to extract direct and indirect ties both incoming and outgoing, as well as estimate the structural holes of the actors. These variables are used to estimate for survival of SMEs after a one-year period using a binary logit model. Findings The study finds that out-indirect ties and structural hole have a significant influence on SME survival. This works through the global influence and the vision advantage that these positions and ties offer the SMEs. Originality/value The study offers SMEs a choice of whom to collaborate with for information (resources) in the form of outgoing and incoming ties at both the global and local level.

scholarly journals Profile of patients admitted in a pulmonology ward and developing Clostridium difficile enterocolitis

Pneumologia ◽  
2019 ◽  
Vol 68 (1) ◽  
pp. 31-36
Author(s):  
Ioana Cojocaru ◽  
Livia Luculescu ◽  
Daniela Negoescu ◽  
Irina Strâmbu
Keyword(s):  
Clostridium Difficile ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Respiratory Infections ◽  
Demographic Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Male Predominance ◽  
Number Of Patients ◽  
Lower Intestine

Abstract Clostridium difficile is an anaerobic bacterium than can colonise the lower intestine and cause enterocolitis in susceptible patients. Clostridium difficile infection (CDI) is typically a nosocomial infection, favoured by treatment with antibiotics (especially with broad-spectrum drugs), proton pump inhibitors, but also comorbidities, old age and prolonged hospitalisation. Based on the observation that in the past years, the frequency of nosocomial CDI has increased in the Institute of Pulmonology, Bucharest, this retrospective observational study aimed to analyse the characteristics of admitted patients who develop CDI, in order to identify possible particular features and risk factors. Accordingly, medical files from 80 patients admitted from January 2015 to August 2017 were analysed for demographic data, respiratory diagnosis, comorbidities, blood tests, treatments prescribed, time of CDI onset, evolution and outcome. The number of patients studied was 29 in 2015, 16 in 2016 and 35 in 2017, with slight male predominance. Totally, 54 patients (67.5%) had tuberculosis (pulmonary or pleural), 12 had lung cancer, five had respiratory infections, two had chronic obstructive pulmonary disease and seven had other diseases. All patients but nine were receiving antibiotics: tuberculosis drugs, cephalosporins, fluoroquinolones and beta-lactams. About half of the patients received proton pump inhibitors. Most patients had several comorbidities. Mean time since admittance to onset of diarrhoea was 20 days. CDI was treated with metronidazole or vancomycin. The evolution was favourable in 90% of patients, but eight patients (10%) died This study highlights a high frequency of CDI in patients treated for tuberculosis. Due to insufficient data, no epidemiological consideration could be made. Further studies are needed to assess the relationship among tuberculosis, tuberculosis treatment and CDI.

scholarly journals The ascent and decline of a great balneological resort: PUCIOASA

2020 ◽  
pp. 498-500
Author(s):  
Doroteea TEOIBAS-SERBAN ◽  
Liviu IORDACHE ◽  
Dan BLENDEA
Keyword(s):  
Water Analysis ◽  
18Th Century ◽  
Local Level ◽  
Iron Concentration ◽  
Long Distance ◽  
Number Of Patients ◽  
The Government ◽  
High Level ◽  
In The Beginning ◽  
Rehabilitation Clinic

Introduction. Pucioasa is one of the greater and sadly, almost forgotten balneological resort of Romania. Known since the 18th century, where it was discovered a record of this area on the Austrian map in 1791 with sulphurous streams, the healing waters of the “Pe Pucioasa” hill enters the therapeutic balneological circle when the first water analysis occurred – 1821-1828 by Dr. Trangot von Schobel. In 1878, Ion Ghica, a prominent figure in Romania at that time initiated the exploitation of 14 wells from the 30 known streams of sulphurous and ferruginous waters, thus obtaining enough healing mineral water for a capacity of 60 beds of the balneological establishment. Since 1841, the Resort developed, transformed into a Rehabilitation Clinic (1969) and the number of patients treated there increased from 20 in the beginning to 1000 patient per day. Many of the patients included foreign elite society members who came regularly to benefit from the waters’ healing properties, both external and internal cures, setting Pucioasa on a high level of not only balneology treatment, but also of balneological tourism. Matherials and methods: Studying local industrializations and water analysis, we concluded that there were many factors that contributed to the decline of this great and international renowned balneological resort. The first wrong step in this direction was made when building and extending de gypsum carrier, the peek being between 1970 and 1975, when the industrial forging process made the sulphurous streams to migrate, and the waters from the wells diminished in its sulphur and iron concentration. Another possible factor for the decline can be the modernisation of the medical world, development of anti-inflammatory drugs and modern medical equipment which reduced the need for the elite society to come a long distance for the balneological treatment. Results: Whichever of the reasons, the once prosperous Balneological Resort of Pucioasa fell into an unknown, unimpressive place, known and frequented only by the locals. The Rehabilitation Clinic still has 60 beds, which are occupied to the maximum each month, it still prospers on a local level, but lost its glory from almost a century ago. Conclusions: The Romanian general population and the government must take an interest to one of the many once prosperous balneological resorts in order to revive the national treasure of Romania which is balneology, which many of the developed European countries only wish that they can possess. Keywords: Balneary Resort, Pucioasa,

scholarly journals Seasonality of Clostridium difficile infections in Southern Germany

2011 ◽  
Vol 140 (10) ◽  
pp. 1787-1793 ◽  
Author(s):  
M. REIL ◽  
M. P. M. HENSGENS ◽  
E. J. KUIJPER ◽  
T. JAKOBIAK ◽  
H. GRUBER ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Southern Germany ◽  
Number Of Patients

SUMMARYBetween 2000 and 2009, the total number of patients with Clostridium difficile infections increased considerably in Southeastern Germany. A clear seasonality was observed with a higher number of affected patients occurring in the winter months (January–March). Moxifloxacin and erythromycin-resistant C. difficile PCR ribotypes 001 (72%) and 027 (4·6%) were the most commonly isolated strains.

scholarly journals Corrigendum to Institutional Factors Contribute to Variation in Intubation Rates in Status Epilepticus

2020 ◽  
Vol 10 (2) ◽  
pp. 155-155
Keyword(s):  
Status Epilepticus ◽  
Nationwide Inpatient Sample ◽  
Personal Information ◽  
Data Use ◽  
Healthcare Research ◽  
Online Version ◽  
Institutional Factors ◽  
Restricted Access ◽  
Number Of Patients ◽  
Inpatient Database

Guterman EL, Burke JF, Josephson SA, and Betjemann JP. Institutional Factors Contribute to Variation in Intubation Rates in Status Epilepticus, The Neurohospitalist. 2019;9:133-139. DOI: 10.1177/1941874418819349 In this article, the supplemental table S1 included cells where the number of patients was < 10 which is in violation of the HCUP data use agreement. A revised online version of the supplemental material that is in compliance with the AHRQ guidelines has been posted online. This article is an analysis of the Nationwide Inpatient Sample (NIS), a large, restricted-access, publicly available dataset and the State Inpatient Database (SID), a restricted-access, publicly available dataset that are maintained by the Agency for Healthcare Research and Quality (AHRQ). One of the provisions of the Data Use Agreement (DUA), which the author signed when purchasing the data, is that no data involving less than or equal to 10 observations are to be published. This measure was put in place by AHRQ to protect individual patients’ privacy and to prevent the potential disclosure of personal information. In the manuscript, there are two tabulated cells in the supplemental table S1 that are in violation of this provision. This represents an oversight on the authors’ part and an inadvertent failure to comply with the Data Use Agreement, for which they apologize. While they are fully confident that nothing in the paper could be used to identify individuals or their personal information, the fact remains that the disclosures are in violation of the AHRQ guidelines

scholarly journals Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

2010 ◽  
Vol 92 (1) ◽  
pp. 56-60 ◽  
Author(s):  
K Gash ◽  
E Brown ◽  
A Pullyblank
Keyword(s):  
Clostridium Difficile ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Fulminant Colitis ◽  
Surgical Morbidity ◽  
Predisposing Factor ◽  
Number Of Patients ◽  
Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

scholarly journals Novel Fidaxomicin Treatment Regimens for Patients With Multiple Clostridium difficile Infection Recurrences That Are Refractory to Standard Therapies

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Melinda M. Soriano ◽  
Larry H. Danziger ◽  
Dale N. Gerding ◽  
Stuart Johnson
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Interquartile Range ◽  
Comparative Data ◽  
Treatment Regimens ◽  
Free Interval ◽  
Number Of Patients

Abstract Reports of fidaxomicin treatment for patients with multiple recurrent Clostridium difficile infections ([mrCDI] ie, more than 2 CDI episodes) indicate symptomatic response to this agent, but 50% have subsequent mrCDI episodes. In an effort to improve outcomes in patients with mrCDI we used novel regimens of fidaxomicin based on strategies used with vancomycin. Of 8 patients who received a 10-day chaser of fidaxomicin given twice daily after a course of vancomycin, 3 (38%) experienced a subsequent recurrence. Two (18%) of 11 patients who completed a 14- to 33-day course of fidaxomicin in a tapering dose experienced a recurrence, both of whom received additional antibiotics before that recurrence. The median symptom-free interval (SFI) after fidaxomicin taper was greater than the median SFI after the most effective prior regimen for those patients (257 days [interquartile range, 280] vs 25 days [interquartile range, 30], respectively; P = .003). A fidaxomicin chaser or taper regimen may be effective in patients with mrCDI, but the number of patients treated is small, and randomized comparative data are not available.

Review of Current Literature on the Economic Burden of Clostridium difficile Infection

2009 ◽  
Vol 30 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Erik R. Dubberke ◽  
Albert I. Wertheimer
Keyword(s):  
Clostridium Difficile ◽  
Economic Burden ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnosis Code ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
Control And Prevention ◽  
Healthcare Associated

Clostridium difficile is well recognized as the most common infectious cause of healthcare-associated diarrhea. Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and virulent illness that is often refractory to treatment. An analysis by the Centers for Disease Control and Prevention revealed that, in the United States, the number of patients discharged from hospitals who received the International Classification of Diseases, Ninth Revision discharge diagnosis code for C. difficile infection (CDI) more than doubled from 2000 to 2003. Unpublished data indicate that this trend has continued and that more than 250,000 US hospitalizations were associated with CDI in 2005. A previously uncommon hypervirulent strain of C. difficile is thought to contribute, in part, to the dramatic increase in the incidence and severity of the infection. Although the economic impact of the disease is believed to be profound and is expected to increase, data on the costs associated with CDI are scarce. To more completely assess its economic burden, we performed a review of available literature that reported costs associated with the infection.

scholarly journals Clostridium difficile-associated diarrhea in the Clinical Center of Vojvodina, Serbia, in the period 2008 to 2012

2014 ◽  
Vol 66 (1) ◽  
pp. 57-64
Author(s):  
Sandra Stefan-Mikic ◽  
Vedrana Petric ◽  
S. Sevic ◽  
Ivana Hrnjakovic-Cvjetkovic ◽  
Vesna Milosevic ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Clostridium Difficile ◽  
Hospital Costs ◽  
Control Measures ◽  
Infectious Disease Clinic ◽  
Disease Clinic ◽  
Clinical Center ◽  
Number Of Patients ◽  
Costs Of Treatment ◽  
Clostridium Difficile Associated Diarrhea

Clostridium difficile-associated diarrhea (CDAD) has been recognized as the leading cause of diarrhea worldwide. In the last five years, it has become the leading cause of diarrhea in the Clinical Center of Vojvodina (CCV) as well. The aim of this study was to determine the epidemiology and total cost of treatment for all patients with Clostridium difficile-associated diarrhea hospitalized at the Infectious Disease Clinic of the CCV; to analyze the costs of treatment with regard to therapeutic approach; to compare the costs of treatment in each year of the investigated period related to the number of patients, and to analyze the outcome of treatment. The study was retrospective, and the data were collected from the medical records of 472 patients with Clostridium difficile diarrhea treated from 2008 to 2012 and analyzed. Of the total 472 patients with CDAD, 54.23% were female and the average age was 65.84. A statistically significant majority of them had been previously treated in other hospitals and a minority in ambulatory settings (395 inpatients vs. 77 outpatients, p=0.000, p<0.05). Of the 395 previously hospitalized patients, most were from the Clinic of Urology of the CCV (58, 14.68%). When comparing therapeutic options, oral vancomycin was significantly more frequently used than other protocols. The average mortality rate during the study period was 6.51%. In this period, total hospital costs related to Clostridium difficile diarrhea in the Infectious Disease Clinic were $636,679.92. Implementation of infection-control measures and a restricted use of antibiotics would result in a great reduction in material costs.

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