Thirty-Day Readmissions in Hospitalized Patients Who Received Bezlotoxumab With Antibacterial Drug Treatment for Clostridium difficile Infection

Vimalanand S Prabhu, Oliver A Cornely, Yoav Golan, Erik R Dubberke, Sebastian M Heimann, Mary E Hanson, Jane Liao, Alison Pedley, Mary Beth Dorr, Stephen Marcella, Vimalanand S Prabhu, Oliver A Cornely, Yoav Golan, Erik R Dubberke, Sebastian M Heimann, Mary E Hanson, Jane Liao, Alison Pedley, Mary Beth Dorr, Stephen Marcella

Abstract

NCT01241552 (MODIFY I) and NCT01513239 (MODIFY II).

Figures

Figure 1.
Figure 1.
A, Proportion of inpatients with Clostridium difficile (CDI)–associated and all-cause hospital readmissions within 30 days of discharge. CI, confidence interval. B, Summary of CDI-associated readmissions within 30 days of discharge in hospitalized participants with high-risk prognostic factors for recurrent CDI. Participants were defined as immunocompromised based on medical history or use of immunosuppressive therapy. Severe CDI was defined as a Zar score ≥2 based on the following scoring system: (1) age >60 years (1 point); (2) body temperature >38.3°C (>100°F) (1 point); (3) albumin level <2.5 g/dL (1 point); (4) peripheral white blood cell count >15 000/μL within 48 hours (1 point); (5) endoscopic evidence of pseudomembranous colitis (2 points); and (6) treatment in an intensive care unit (2 points).

References

    1. Johnson S, Louie TJ, Gerding DN et al. ; Polymer Alternative for CDI Treatment (PACT) investigators Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis 2014; 59:345–54.
    1. Louie TJ, Miller MA, Mullane KM et al. ; OPT-80-003 Clinical Study Group Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011; 364:422–31.
    1. Sheitoyan-Pesant C, Abou Chakra CN, Pépin J, Marcil-Héguy A, Nault V, Valiquette L. Clinical and healthcare burden of multiple recurrences of Clostridium difficile infection. Clin Infect Dis 2016; 62:574–80.
    1. Shivashankar R, Khanna S, Kammer PP et al. . Clinical predictors of recurrent Clostridium difficile infection in out-patients. Aliment Pharmacol Ther 2014; 40:518–22.
    1. Bauer MP, Notermans DW, van Benthem BH et al. ; ECDIS Study Group Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011; 377:63–73.
    1. Lessa FC, Mu Y, Bamberg WM et al. . Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372:825–34.
    1. Morrison RH, Hall NS, Said M et al. . Risk factors associated with complications and mortality in patients with Clostridium difficile infection. Clin Infect Dis 2011; 53:1173–8.
    1. See I, Mu Y, Cohen J et al. . NAP1 strain type predicts outcomes from Clostridium difficile infection. Clin Infect Dis 2014; 58:1394–400.
    1. Kelly CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 2012; 18suppl 6:21–7.
    1. Abou Chakra CN, Pepin J, Sirard S, Valiquette L. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLoS One 2014; 9:e98400.
    1. Rao K, Safdar N. Fecal microbiota transplantation for the treatment of Clostridium difficile infection. J Hosp Med 2016; 11:56–61.
    1. Inns T, Gorton R, Berrington A et al. . Effect of ribotype on all-cause mortality following Clostridium difficile infection. J Hosp Infect 2013; 84:235–41.
    1. Desai K, Gupta SB, Dubberke ER, Prabhu VS, Browne C, Mast TC. Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach. BMC Infect Dis 2016; 16:303.
    1. Asensio A, Di Bella S, Lo Vecchio A et al. . The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study. Int J Infect Dis 2015; 36:31–8.
    1. Le Monnier A, Duburcq A, Zahar JR et al. ; GMC Study Group Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals. J Hosp Infect 2015; 91:117–22.
    1. Heimann SM, Vehreschild JJ, Cornely OA et al. . Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital. Infection 2015; 43:707–14.
    1. Vincent C, Miller MA, Edens TJ, Mehrotra S, Dewar K, Manges AR. Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection. Microbiome 2016; 4:12.
    1. Dubberke ER, Carling P, Carrico R et al. . Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35:628–45.
    1. Chopra T, Neelakanta A, Dombecki C et al. . Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program. Am J Infect Control 2015; 43:314–7.
    1. Olsen MA, Yan Y, Reske KA, Zilberberg M, Dubberke ER. Impact of Clostridium difficile recurrence on hospital readmissions. Am J Infect Control 2015; 43:318–22.
    1. Wilcox MH, Gerding DN, Poxton IR et al. ; MODIFY I and MODIFY II Investigators Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N Engl J Med 2017; 376:305–17.
    1. Elixhauser A, Steiner C, Gould C. Readmissions following hospitalizations with Clostridium difficile infections, 2009: statistical brief #145 2012. Available at: . Accessed 14 July 2017.
    1. Miettinen O, Nurminen M. Comparative analysis of two rates. Stat Med 1985; 4:213–26.
    1. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007; 45:302–7.
    1. Shin JH, Chaves-Olarte E, Warren CA. Clostridium difficile infection. Microbiol Spectr 2016; 4:1–21. doi:10.1128/microbiolspec.EI10-0007-2015.
    1. Lee CH, Steiner T, Petrof EO et al. . Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA 2016; 315:142–9.
    1. Gerding DN, Meyer T, Lee C et al. . Administration of spores of nontoxigenic Clostridium difficile strain M3 for prevention of recurrent C. difficile infection: a randomized clinical trial. JAMA 2015; 313:1719–27.
    1. Carter GP, Chakravorty A, Pham Nguyen TA et al. . Defining the roles of TcdA and TcdB in localized gastrointestinal disease, systemic organ damage, and the host response during Clostridium difficile infections. MBio 2015; 6:e00551.
    1. Gupta SB, Mehta V, Dubberke ER et al. . Antibodies to toxin B are protective against Clostridium difficile infection recurrence. Clin Infect Dis 2016; 63:730–4.
    1. Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012; 55suppl 2:S88–92.
    1. Shah DN, Aitken SL, Barragan LF et al. . Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study. J Hosp Infect 2016; 93:286–9.

Source: PubMed

3
Abonner