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The CDI Burden in Surgery

The CDI Burden in Surgery

Despite increased national attention, the incidence of Clostridium difficile infection (CDI) and its associated financial and human costs continue to grow. In fact, the problem has become so critical that CMS would no longer reimburse hospitals for claims associated with this potentially preventable infection if it is acquired during the hospital stay. There are also concerns that new strains of the infection may cause resistance to traditional antibiotic regimens. Recent data have also shown that the burden of CDI is increasing among surgical patients. This is concerning given that surgical care accounts for about 40% to 50% of all hospital stays and healthcare dollars. “Surgery patients frequently receive prophylactic antibiotics and have longer inpatient hospital exposure,” explains Zaid M. Abdelsattar, MD, MSc. Previous reports on how CDI affects surgical patients has been limited by the use of administrative data and failure to capture cases diagnosed after discharge, and reports from single-center studies. A Large-Scale Analysis In a study published in Infection Control & Hospital Epidemiology, Dr. Abdelsattar and colleagues conducted a large-scale analysis of patients with postoperative CDI after 40 different surgeries at 52 academic and community hospitals for a period of about 1 year. The purpose of the analysis—which included more than 35,000 patients in total—was to identify CDI risk factors and determine the impact of the infection on resource utilization. According to the results, only about 0.5% of the study group developed CDI after surgery, but postoperative CDI rates varied significantly between surgical procedures. Three surgical groups had higher adjusted odds ratios (aOR) of postoperative CDI: Lower-extremity amputations: aOR,3.5. Gastric or esophageal operations: aOR, 2.1. Bowel resection...
A Helpful Guide for CDI Prevention

A Helpful Guide for CDI Prevention

According to the CDC, the mortality rate associated with Clostridium difficile infection (CDI) increased by 400% between 2000 and 2007, due in part to a stronger germ strain. CDI accounts for approximately 14,000 deaths each year in the United States. Current estimates show that the average total cost for a single inpatient CDI is more than $35,000, and the estimated annual cost burden for the healthcare system exceeds $3 billion. “Preventing the transmission of CDI continues to be a serious and difficult challenge in hospitals throughout the U.S.,” says Ruth M. Carrico, PhD, RN, FSHEA, CIC. “The epidemiology of CDI is changing [Figure]. Its presence in hospitals and other health-care settings has caused medical personnel across the entire continuum of care to reevaluate approaches and perspectives to preventing and managing this potentially lethal infection.” A National Action Plan on CDI Prevention The U.S. Department of Health and Human Services released the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination in 2009. The document, available at www.hhs.gov, provides a roadmap for preventing healthcare-associated infections (HAIs) in acute care hospitals, ambulatory surgical centers, long-term care facilities, and other healthcare settings. CDIs were among the first HAIs specifically targeted in the action plan because rates have been increasing in recent years. The Association for Professionals in Infection Control and Epidemiology (APIC) has been involved in promoting and supporting the elements included in this national plan through development of specific guidance aimed at the healthcare practice level. In 2013, APIC issued an updated implementation guide to help clinicians further protect patients from CDI. The update contains new material and revised content...

Patients With CKD Have Higher Rates of CDI

Patients with chronic kidney disease (CKD) appear to have a higher risk of Clostridium difficile infection (CDI) and hospital-associated morbidity and mortality when compared with patients who do not have CKD. A team of American researchers found that patients with CKD had a CDI rate of 1.49%, compared with a 0.70% rate for those without CKD. Abstract: Mayo Clinic Proceedings, November...

CDI: Making the Case for Better Prevention Efforts

Clostridium difficile infection (CDI) is a common and sometimes fatal healthcare–associated infection. It manifests as diarrhea that often recurs and can progress to toxic megacolon, sepsis, and death. “The incidence, mor­tality, and healthcare costs resulting from CDIs in hospitalized patients have reached historic highs,” says L. Clifford McDonald, MD, FACP, FSHEA. “CDI often occurs in patients in healthcare settings where antibiotics are prescribed and symp­tomatic patients are concentrated.” From 2000 to 2009, the number of hospitalized patients with any CDI discharge diagnoses more than doubled; the number with a primary CDI diagnosis more than tripled. “While the incidence of other healthcare-associated infections has declined, the incidence of CDI has increased,” Dr. McDonald says. Evidence-based guidelines are available for preventing CDI in hospitals, but the degree to which adherence to these guidelines can effectively help prevent these infections is unknown. Analyzing the Impact of CDI In the March 13, 2012 Morbidity & Mortality Weekly Report, Dr. McDonald and colleagues published a study that sought to identify healthcare exposures for CDI, determine the pro­portion of CDI occurring outside hospital settings, and assess whether prevention programs can effectively reduce CDI. The research team analyzed population-based data from the Emerging Infections Program as well as present-on-admission and hospital-onset, laboratory-identified CDI events that were reported to the National Healthcare Safety Network (NHSN). When analyzing data from the Emerging Infec­tions Program, 10,342 CDIs were identified. “Overall, 94% of all CDIs were related to various precedent and concurrent healthcare exposures,” says Dr. McDonald. “About three-fourths of CDIs had their onset occur outside of hospitals [Figure 1]. It should also be noted that some cases occurred in...

Preventing Clostridium Difficile Infections

According to published data, Clostridium difficile infection (CDI) now rivals MRSA as the most common organism to cause healthcare-associated infections (HAIs) in the United States. The pro­portion of hospital discharges in which patients received a diagnostic code for CDI more than doubled between 2000 and 2003, and rates continued to increase in 2004 and 2005. “In addition to increased frequency of CDI, current research also shows that these infections are increasing in severity,” says Erik R. Dubberke, MD. CDI has been associated with increased lengths of hospital stay, higher costs, and greater morbidity and mortality. According to study data, CDI has been shown to increase lengths of hospital stay by about 3 days. Costs have also been significant; the total U.S. hospital costs for CDI management have been estimated at about $3.2 billion per year. The infection has been associated with attributable mortality rates of 16.7% at 1 year. New Guidance In 2008, a task force to create a concise compendium of recommendations for the prevention of common HAIs was appointed by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America. Recommendations were published in the October 2008 supplement to Infection Control and Hospital Epidemiology and are available at www.preventingHAIs.com. The document is designed to help hospitals focus and prioritize their efforts to implement evidence-based practices for the prevention of HAIs, including CDI. According to the compendium recommendations, fluoroquinolones had been infrequently associated with CDI. However, new research has found that these agents are one of the primary predisposing antimicrobials associated with the infection. “Most antibiotics have been associated with CDI,” explains Dr. Dubberke....
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