Article

The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

Clinical Quality and Performance Management, Ottawa Hospital, Ottawa, Ontario, Canada.
Archives of internal medicine (Impact Factor: 13.25). 11/2010; 170(20):1804-10. DOI: 10.1001/archinternmed.2010.405
Source: PubMed

ABSTRACT The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission.
This retrospective observational study used data from the Ottawa Hospital (Ottawa, Ontario, Canada) data warehouse. Inpatient admissions with a start date after July 1, 2002, and a discharge date before March 31, 2009, were included. Stratified analyses and a Cox multivariate proportional hazards regression model were used to determine if hospital-acquired CDI was associated with time to in-hospital death.
A total of 136 877 admissions were included. Hospital-acquired CDI was identified in 1393 admissions (overall risk per admission, 1.02%; 95% confidence interval [CI], 0.97%-1.06%). The risk of hospital-acquired CDI significantly increased as the baseline mortality risk increased: from 0.2% to 2.6% in the lowest to highest deciles of baseline risk. Hospital-acquired CDI significantly increased the absolute risk of in-hospital death across all deciles of baseline risk (pooled absolute increase, 11%; 95% CI, 9%-13%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI (95% CI, 2.4-3.7); this hazard ratio decreased with increasing baseline mortality risk.
Hospital-acquired CDI was independently associated with an increased risk of in-hospital death. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.

Download full-text

Full-text

Available from: Monica Taljaard, Aug 30, 2015
0 Followers
 · 
127 Views
  • Source
    • "We are testing our approach in a Clinical Intelligence scenario dedicated to the surveillance for, and research on Hospital-Acquired Infections (HAI). To this end, we are prototyping a SADI-based infrastructure for semantic querying of a relational database used by The Ottawa Hospital (TOH) and containing an extract from the large TOH datawarehouse accumulating data from the most important IT systems of the hospital (see, e.g., [21,22]). Our infrastructure consists of an ontology defining concepts suitable for reasoning about Hospital-Acquired Infections, and a number of SADI services drawing data from the DB, as well as several general purpose services dealing with information about drugs, diseases and infectious agents. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Clinical Intelligence, as a research and engineering discipline, is dedicated to the development of tools for data analysis for the purposes of clinical research, surveillance, and effective health care management. Self-service ad hoc querying of clinical data is one desirable type of functionality. Since most of the data are currently stored in relational or similar form, ad hoc querying is problematic as it requires specialised technical skills and the knowledge of particular data schemas. Results A possible solution is semantic querying where the user formulates queries in terms of domain ontologies that are much easier to navigate and comprehend than data schemas. In this article, we are exploring the possibility of using SADI Semantic Web services for semantic querying of clinical data. We have developed a prototype of a semantic querying infrastructure for the surveillance of, and research on, hospital-acquired infections. Conclusions Our results suggest that SADI can support ad-hoc, self-service, semantic queries of relational data in a Clinical Intelligence context. The use of SADI compares favourably with approaches based on declarative semantic mappings from data schemas to ontologies, such as query rewriting and RDFizing by materialisation, because it can easily cope with situations when (i) some computation is required to turn relational data into RDF or OWL, e.g., to implement temporal reasoning, or (ii) integration with external data sources is necessary.
    Journal of Biomedical Semantics 03/2013; 4(1):9. DOI:10.1186/2041-1480-4-9 · 2.62 Impact Factor
  • EXPLORE The Journal of Science and Healing 05/2013; 9(3):188-91. DOI:10.1016/j.explore.2013.03.006 · 0.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clostridium difficile infection (CDI) is most commonly diagnosed using toxin enzyme immunoassays (EIAs). A sudden decrease in CDI incidence was noted after a change in the EIA used at Barnes-Jewish Hospital in St Louis. The objective of this study was to determine whether the decreased CDI incidence related to the change in EIA resulted in adverse patient outcomes. Electronic hospital databases were used to collect data on demographics, outcomes, and treatment of inpatients who had a C difficile toxin assay performed between January 4, 2009, and April 3, 2009 (period A, preassay change) and between May 21, 2009, and August 17, 2009 (period B, postassay change). Assays were positive in 240 of 1,221 patients (19.7%) during period A and in 106 of 1160 patients (9.1%) during period B (P < .01). There was no difference in mortality or discharge to hospice between the 2 periods (10.3% vs 10.1%; P = .90). Patients tested in period B were less likely to receive metronidazole or oral vancomycin (P < .01). The new EIA resulted in fewer positive tests and reduced anti-CDI therapy. There was no difference in mortality between the 2 periods, suggesting that the decreased incidence was due to increased assay specificity, not decreased sensitivity.
    American journal of infection control 07/2011; 40(4):349-53. DOI:10.1016/j.ajic.2011.04.002 · 2.33 Impact Factor
Show more