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Postoperative Burden of Hospital-Acquired Clostridium difficile Infection

Published online by Cambridge University Press:  05 January 2015

Zaid M. Abdelsattar ,
Greta Krapohl ,
Layan Alrahmani ,
Mousumi Banerjee ,
Robert W. Krell ,
Sandra L. Wong ,
Darrell A. Campbell Jr ,
David M. Aronoff  and
Samantha Hendren
Zaid M. Abdelsattar*
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Greta Krapohl
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Layan Alrahmani
Affiliation:
Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
Mousumi Banerjee
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Robert W. Krell
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Sandra L. Wong
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
Darrell A. Campbell Jr
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
David M. Aronoff
Affiliation:
Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
Samantha Hendren
Affiliation:
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
*
Address correspondence to Zaid Abdelsattar, MD, Department of Surgery, University of Michigan, Center for Healthcare Outcomes & Policy, 2800 Plymouth Rd, Building 16, Rm 100N-24, Ann Arbor, MI 48109 ([email protected]).
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Abstract

OBJECTIVE

Clostridium difficile infection (CDI) is a common hospital-acquired infection. Previous reports on the incidence, risk factors, and impact of CDI on resources in the surgical population are limited. In this context, we study CDI across diverse surgical settings.

METHODS

We prospectively identified patients with laboratory-confirmed postoperative CDI after 40 different general, vascular, or gynecologic surgeries at 52 academic and community hospitals between July 2012 and September 2013. We used multivariable regression models to identify CDI risk factors and to determine the impact of CDI on resource utilization.

RESULTS

Of 35,363 patients, 179 (0.51%) developed postoperative CDI. The highest rates of CDI occurred after lower-extremity amputation (2.6%), followed by bowel resection or repair (0.9%) and gastric or esophageal operations (0.7%). Gynecologic and endocrine operations had the lowest rates (0.1% and 0%, respectively). By multivariable analyses, older age, chronic immunosuppression, hypoalbuminemia (≤3.5 g/dL), and preoperative sepsis were associated with CDI. Use of prophylactic antibiotics was not independently associated with CDI, neither was sex, body mass index (BMI), surgical priority, weight loss, or comorbid conditions. Three procedure groups had higher odds of postoperative CDI: lower-extremity amputations (adjusted odds ratio [aOR], 3.5; P=.03), gastric or esophageal operations (aOR, 2.1; P=.04), and bowel resection or repair (aOR, 2; P=.04). Postoperative CDI was independently associated with increased length of stay (mean, 13.7 d vs 4.5 d), emergency department presentations (18.9 vs 9.1%) and readmissions (38.9% vs 7.2%, all P<.001).

CONCLUSIONS

Incidence of postoperative CDI varies by surgical procedure. Postoperative CDI is also associated with higher rates of extended length of stay, emergency room presentations, and readmissions, which places a potentially preventable burden on hospital resources.

Infect Control Hosp Epidemiol 2015;36(1): 40–46

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 40 - 46
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Previous presentation. This work was presented in part at the American Society of Colon and Rectal Surgeons’ Annual Meeting in Hollywood, FL, on May 19, 2014.

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