Influence of cohorting patients with Clostridium difficile infection on risk of symptomatic recurrence

Islam, J, Cheek, E, Navani, V, Rajkumar, C, Cohen, J and Llewelyn, M J (2013) Influence of cohorting patients with Clostridium difficile infection on risk of symptomatic recurrence. Journal of Hospital Infection, 85 (1). pp. 17-21. ISSN 0195-6701

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Abstract

BACKGROUND

Cohorting of patients with Clostridium difficile infection (CDI) is recommended when single side-rooms are unavailable. Although patients may remain infectious after cessation of diarrhoea, continued cohorting may place them at increased risk of reinfection.

AIM

To identify risk factors for CDI recurrence and to determine whether cohorting of patients is associated with increased risk of recurrence.

METHODS

Data describing patient demographics, comorbidity, CDI severity and treatment were collected for 248 CDI patients at our hospital between October 2008 and June 2011. The primary outcome was symptomatic recurrence within 30 days of diagnosis.

FINDINGS

One hundred and thirty-eight (55.6%) CDI patients were admitted to the cohort ward. These patients were more likely to have severe CDI (odds ratio: 1.95; 95% confidence interval: 1.10-3.46; P = 0.022) and receive vancomycin (1.59; 0.94-2.68; P = 0.083) than patients who were not cohorted. Twenty-six patients (10.5%) suffered recurrence (21 cohorted and five not cohorted). Urinary infection on admission (5.16; 2.10-12.64; P < 0.001), cohorting (3.77; 1.37-10.35; P = 0.01) and concomitant antibiotics (2.07; 0.91-4.72; P = 0.083) were associated with increased risk of recurrence. On multivariate analysis, cohorting (3.94; 1.23-12.65; P = 0.021) and urinary infection (4.27; 1.62-11.24; P = 0.003) were significant predictors of recurrence.

CONCLUSION

Patients admitted to a C. difficile cohort ward may be at increased risk of recurrence because they are at increased risk of reinfection. Hospitals using cohort wards to control C. difficile should manage patient flow through the cohort to minimize this risk.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
Subjects: R Medicine
Depositing User: Sandy Gray
Date Deposited: 15 Sep 2014 12:49
Last Modified: 02 Aug 2017 17:46
URI: http://sro.sussex.ac.uk/id/eprint/49933
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