TY - JOUR
T1 - National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014
AU - Reveles, Kelly R.
AU - Lawson, Kenneth A.
AU - Mortensen, Eric M.
AU - Pugh, Mary Jo V.
AU - Koeller, Jim M.
AU - Argamany, Jacqueline R.
AU - Frei, Christopher R.
N1 - Funding Information:
This study was supported, in part, by an American College of Clinical Pharmacy Research Institute Futures Grant, awarded to K.R.R. This material is also the result of work supported with resources and the use of facilities at the Audie L. Murphy Memorial VA Hospital, San Antonio, TX. Furthermore, K.R.R. is supported by the National Institutes of Health/National Institute on Aging San Antonio Claude D. Pepper Older Americans Independence Center (1P30AG044271-01A1) Career Development (KL2) Program. Finally, C.R.F. is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR001120. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the views of the U.S. Department of Veterans Affairs, the United States Government, or the National Institutes of Health. This material is the result of work supported with resources and the use of facilities at the Audie L. Murphy Memorial VA Hospital, San Antonio, TX.
Publisher Copyright:
© 2017 Reveles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2017/12
Y1 - 2017/12
N2 - Introduction: Prior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally. Results: Overall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days). Conclusions: Initial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes.
AB - Introduction: Prior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period. Methods: This was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally. Results: Overall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days). Conclusions: Initial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes.
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U2 - 10.1371/journal.pone.0189227
DO - 10.1371/journal.pone.0189227
M3 - Article
C2 - 29216276
AN - SCOPUS:85037333540
SN - 1932-6203
VL - 12
JO - PLoS One
JF - PLoS One
IS - 12
M1 - e0189227
ER -