Patients with C Difficile Discharged to Higher Levels of Care

Kelly R. Reveles, PharmD, PhD

Patients with Clostridium difficile infection at hospital discharge required a higher level of medical care residence compared to patients without the infection, according to a recent study. The patients who weren’t discharged home were most often discharged to nursing home or long-term care facilities.

Nearly 1 in 5 patients with C difficile were discharged somewhere other than their home (18%), investigators found, while that number was just 8% in the control group. When the patients didn’t go home, the most common discharges were to hospice/death (12%) or to a nursing home or long-term care facility (6%).

Researchers from UT Health San Antonio compared the nationally representative Veterans Health Administration (VHA) patient database with non-VHA hospitalized patients in the Houston area. They gathered data about admission and discharge disposition from both patient groups, as well as incidence of and clinical and microbiological risk factors for non-home discharges. There were 15,173 VHA patients with C difficile infection and 48,599 hospitalized patients without the infection.

The impact of C difficile infection after hospital discharge was poorly understood, wrote study authors, and their work aimed to determine patient discharge disposition and to understand which risk factors contributed to a discharge somewhere other than the patients’ homes.

“In this study, we demonstrated that hospitalized patients with C difficile infection have a higher likelihood of requiring a higher level of healthcare at discharge compared to non-C difficile infection controls,” study author Kelly R. Reveles, PharmD, PhD told MD Magazine®. “It was most surprising that C difficile infection remained significantly associated with a non-home discharge even after controlling for age and other comorbidities.”

The researchers discovered there were several C difficile infection patient characteristics that significantly increased the risk factors for a non-home discharge. One of those was severity of infection—or even recurrent infection—the study authors said.

“The most surprising finding in this analysis was that the recent epidemic ribotype 027 strain was associated with a non-home discharge, as were 2 other less frequently isolated ribotypes,” Reveles continued. The other ribotypes linked to non-home discharge were strains F001 and F053-163.

She added that the team’s research provided strong evidence that certain hospitalized patients with C. difficile infection were at a higher risk for a discharge to a non-home setting, such as nursing home or other type of long-term care facility, compared to hospitalized patients who did not acquire a C difficile infection.

“The findings support aggressive C difficile infection preventative approaches, such as optimal infection control practices and appropriate use of antibiotics, as well as the need for innovative treatment strategies to improve the outcomes for patients with C difficile infection,” Reveles concluded.

The study, “Clostridioides (formerly Clostridium) difficile infection during hospitalization increases the likelihood of non-home patient discharge,” was published in Clinical Infectious Diseases.