Digging Deeper on Risk for Primary and Recurrent C. difficile Infection in Medicare Patients

Reviewed by Cindy Noyes, MD; University of Vermont Medical Center, Burlington, VT

Feurerstadt et al describe a retrospective cohort of 268,762 Medicare beneficiaries spanning 2010 through 2016 with primary or recurrent Clostridioides difficile infection (CDI) based on claims submitted for inpatient or outpatient care attributable to CDI and confirmation that appropriate treatment followed.  Those who developed CDI were older and more likely to have received antecedent antibiotics and gastric acid suppression. Thirty-four percent of those with an index CDI developed recurrence and almost 60% of those with at least one recurrence developed two or more.  The proportion of patients having received either solid organ or hematologic transplant was nine times higher in those with three or more recurrent episodes as compared to those without recurrence.   Healthcare utilization, including hospitalization, emergency room visits and outpatient care, was higher during the 6 months just prior to CDI onset compared to months 7 through 12 preceding the infection.  Post infection complications included a new diagnosis of anxiety, delirium and depression in up to 18% and sepsis within the first 12 months following CDI in 30% of patients, further characterizing the medical frailty of this group.  

References: Feuerstadt P, et al (2022).  Clinical burden of recurrent Clostridioides difficile infection in the medicare population: A real world claims analysis.  Antimicrobial Stewardship and Healthcare Epidemiology, https://doi.org/10.1017/ash.2022.2.

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