178110 Evaluation of RISK Factors of Clostridium Difficile Associated Diarrhea (CDAD) in MEDICINE and Surgical Inpatients

Tuesday, October 28, 2008: 1:00 PM

Mandeep Matta, MD , Geriatric Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
Sofia Novak, MD , Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
Hashim Nemat, MD , Geriatric Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
Martin Lesser, PhD , Feinstein Institute, North Shore - LIJ Health System, Manhasset, NY
Roshan Hussain, MPH, MBA , Krasnoff Quality Management Institute, Great Neck, NY
Barbara T. Edwards, MD , Infectious Diseases, Long Island Jewish Medical Center, New Hyde Park, NY
Yosef Dlugacz, PhD , Krasnoff Quality Management Institute, Great Neck, NY
Gisele Wolf-Klein, MD , Geriatric Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
Introduction: Clostridium difficile Associated Diarrhea (CDAD) is a leading cause of nosocomial diarrhea, creating a major economic burden in Health Care. At a major teaching tertiary care center, a preliminary epidemiological survey revealed a striking discrepancy in the distribution of nosocomial CDAD in Medicine (73.8%) and Surgery (8%). Thus, we proposed to compare the distribution of the risk factors for CDAD in Medicine and Surgical Services.

Methods: A retrospective random sampling review of 94 Medicine and 76 Surgery charts of patients discharged between March 2004-July 2006 was conducted. We studied the distribution of various risk factors for CDAD in Medicine and Surgery patients: age, length of stay (LOS), admission source(community vs.skilled nursing facilities-SNF), readmission to hospital within 90 days, discharge disposition, prior history of CDAD, albumin level, use of antibiotics and Proton Pump Inhibitors (PPIs), immunosuppression, chemotherapy and hemodialysis.

Results : Patients admitted to Medicine were significantly older than in Surgery (mean age:79.7 v.75.1, p<.001), though their LOS were similar (6.5 days v.5.1, p=0.178). There was a remarkable difference between admission sources, with SNF transfers accounting for 15.7% of medical admissions versus only 1.3% of surgical (p=.001). Similarly, 29.2% of Medicine patients were discharged to SNF compared to 9.2% of surgical patients (p=.001). Readmissions within 90 days accounted for 31.5% of Medicine patients, compared with 11.1% of Surgical patients (p=.002). Serum albumin levels were lower in Medicine (3.7g/dl) than in Surgery (3.9 g/dl, p=.045). Almost half (44.7%) of Medical patients were prescribed PPIs, compared to 37.1% of surgical patients (p=.022). Finally, antibiotics were prescribed to 47.9% of medical and 60% of surgical patients, most of whom receiving single dose prophylaxis (p<.001). Prior history of CDAD, immunosuppresion, chemotherapy and hemodialysis were not significant risk factors in either group.

Conclusion: These results support age, low serum albumin and use of PPIs as known risk factors for CDAD. In addition, this study outlines socio-demographic risk factors, namely the role of SNF for both admission and discharge sites, as strong predictors of CDAD.

Learning Objectives:
To support the research stating age, low serum albumin and use of PPIs as known risk factors for CDAD. To highlight the need for heightened awareness of CDAD risk factors in Medicine. To outline socio-demographic risk factors, namely the role of SNF for both admission and discharge sites, as strong predictors of CDAD.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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