Epidemiology and Outcomes of Clostridium difficile-Associated Disease Among Patients on Prolonged Acute Mechanical Ventilation.
Chest. 2009 May 22;
Authors: Zilberberg MD, Nathanson BH, Sadigov S, Higgins TL, Kollef MH, Shorr AF
Purpose Patients on prolonged acute mechanical ventilation (PAMV), though comprising one third of all MV patients, consume two thirds of all the resources allocated to MV, and their numbers are projected to double by year 2020. By virtue of their prolonged hospital length of stay (LOS, median 17 days), they are subject to such nosocomial infections as Clostridium difficile-associated disease (CDAD), whose incidence and age-adjusted case fatality rate have doubled between 2000 and 2005. We examined the rates and outcomes of CDAD among adult PAMV patients. Methods We analyzed 2005 data from the Health Care Utilization Project (HCUP)/Nationwide Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality (AHRQ). PAMV and CDAD were identified using the ICD-9-CM codes 96.72 and 008.45, respectively. Results Among 64,910 adult PAMV discharges in 2005, 3,468 (5.34%) had a concurrent diagnosis of CDAD. CDAD+ discharges were older (66.7 +/- 15.9 vs 63.7 +/- 16.9 years, p < 0.001), and more likely to be admitted from a long-term facility (5.7%vs 2.9%, p < 0.001) than CDAD-. While crude hospital mortality did not differ among PAMV discharges by CDAD status (32.6%CDAD+ and 33.0%CDAD-, p = 0.598), both unadjusted calculations and propensity-score adjustment showed a substantial increase in LOS (6.1 days; 95%CI 4.9-7.4) and total costs ($10,355; 95%CI $7,540-$13,170) among CDAD+ discharges. Conclusions PAMV patients have an order of magnitude higher risk of CDAD than other hospitalized patients. Concurrent CDAD infection is associated with increased hospital LOS and costs. PAMV population is an attractive target for aggressive measures aimed at CDAD prevention.
PMID: 19465510 [PubMed - as supplied by publisher]