Chaitanya Pant

Case Western Reserve University, Cleveland, Ohio, United States

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Publications (37)96.96 Total impact

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    ABSTRACT: Abstract Objective: To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding-associated emergency department (ED) visits in the U.S. Methods: Estimates of GI bleeding-associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample (NEDS). Results: From 2006 - 2011, there were an estimated total of 437,283 ED visits associated with diagnosis of GI bleeding. Specifically, there were 88,675 cases of upper GI bleeding, 132,102 cases of lower GI bleeding and 217,008 cases of unspecified GI bleeding. GI bleeding-associated ED visits increased from 82.2/100,000 children in 2006 to 93.9/100,000 children in 2011 (14.3% increase; P<0.01). The rate of increase was chiefly noted for lower GI bleeding (31.3%) followed by unspecified GI bleeding (10.4%) with a relatively minor increase in upper GI bleeding (1.1%). The greatest number of visits occurred in children 15 - 19 years of age (39.2%). A majority of patients underwent routine discharge (80.8%). Risk factors independently associated with an increased rate of hospital admission included ≥3 comorbid conditions (adjusted odds ratio [aOR] 112.2; 95% CI 103.4 -121.7), presentation to a teaching hospital (aOR 3.2; 95% CI 3.1 - 3.2), the presence of upper GI bleeding (aOR 3.1; 95% 3.0 - 3.2), health coverage with private insurance (aOR 1.6; 95% CI 1.6 - 1.7) and children < 5 years of age (aOR 1.3; 95% CI 1.2 - 1.3). Conclusion: Our results indicate that there has been an increasing incidence of GI bleeding-associated ED visits in children from 2006 - 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the U.S.
    Current Medical Research and Opinion 12/2014; · 2.37 Impact Factor
  • Infection Control and Hospital Epidemiology 12/2014; 35(12):1547-8. · 3.94 Impact Factor
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    ABSTRACT: Objectives The objective was to estimate emergency department (ED) visits for Clostridium difficile infection in the United States for the years 2006 through 2010.Methods Estimates of ED visits for C. difficile infection were calculated in patients 18 years and older using the Nationwide Emergency Department Sample.ResultsDuring the calendar years 2006 through 2010, there were an estimated total of 491,406,018 ED visits. Of these, 462,160 ED visits were associated with a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of C. difficile. The C. difficile infection ED visit rate (visits/100,000 census population) increased from 34.1 in 2006 to 42.3 in 2010, an increase of 24% (p < 0.01). There was also a significant overall increased trend in the number of ED visits for C. difficile from 2006 through 2010 (p < 0.01). The highest ED visit rate for C. difficile was observed for patients 65 years and older (163.18 per 100,000), while the lowest visit rate was for patients aged 18 to 24 years (5.10 per 100,000). The greatest increase in C. difficile infection visits occurred in the age group 18 to 24 years.Conclusions These results indicate an increased trend of ED visits for C. difficile in the period 2006 through 2010 with an overall population-adjusted increase of 24%. This represents important complementary data to previous studies reporting an increase in the rate of C. difficile infections in the U.S. hospitalized population.
    Academic Emergency Medicine 12/2014; · 2.20 Impact Factor
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    ABSTRACT: Background: Patients with cystic fibrosis (CF) are reported to have a high asymptomatic carriage rate of Clostridium difficile (C. difficile). However, most reports are limited to case reports and case series. The objective of this study was to investigate the incidence of C. difficile infection (CDI) in hospitalized patients with CF in the United States. Methods: Data were obtained from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2002 to 2010. Data were weighted to generate national-level estimates. Results: For the year 2010, there were a total of 9,706,097 weighted hospital discharges in the 18 – 44 year age group. In this age cohort, 32,541 patients had a diagnosis of CDI and 19,278 patients had a diagnosis of CF. The incidence of CDI in the hospitalized CF population was 1.6% compared to an incidence of 0.3% in the non-CF hospitalized population (P<0.05). After matching to control for demographic factors and comorbidities; patients with CF continued to have a higher risk for CDI than their matched counterparts (OR 3.0 95% CI 2.6-3.5). Patients with CF + CDI had an overall worse outcome than patients with CDI only (P<0.05). Utilizing a multiple variable regression model, patients in the CF + CDI group continued to demonstrate poor outcomes compared to patients in the CDI only group. This was evident as a higher risk of death (adjusted odds ratio (aOR) 3.1 95% CI 1.9-5.1), colectomy (aOR 2.6 95% CI 1.3-5.3) and higher hospital charges (adjusted regression coefficient $42,000 95% CI $22,000- $62,000). The difference in LOS between the two groups was not significant (adjusted regression coefficient 3.3 days 95% CI 0.81-5.8 days). Between the years 2002 – 2010, the incidence of CDI in the hospitalized CF population (ages 18 – 44 years) increased from 0.9% to 1.6% whereas the incidence of CDI in the corresponding non-CF population increased from 0.2% to 0.3%. For both these groups, this represented a significant increasing trend in the incidence of CDI (P<0.05). Conclusion: There was an increasing trend in the incidence of CDI complicating CF in the years 2002 - 2010. CDI had worse outcomes (higher risk of death, colectomy and hospital charges) in the setting of CF.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: There has been an alarming uptrend in the number of cases of C. difficile infection (CDI) after the introduction of real-time PCR based diagnostic testing. The objective of this study was to interrogate a nationwide emergency department (ED) database to determine the trend of ED visits related to CDI for the years 2006-2010. Methods: Data were obtained from the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2006-2010. Data were weighted to generate national-level estimates. Results: For years 2006–2010, a weighted total of 462,160 patients were discharged from the ED with a primary diagnosis of CDI. The rate (cases/100,000 population) of ED visits with CDI as a primary diagnosis increased from 34.08 in 2006 to 42.37 in 2010; this represented an increase of 24.32% (P<0.01). There was an increased trend in the number of ED visits with CDI as a primary diagnosis from 2006–2010 (P<0.01). The highest incidence rate of CDI related ED visits was observed patients ≥ 65 years, while the lowest incidence was in patients 18–24 years. Of the 462,160 patient cohort, 92.48% of cases were admitted as inpatients to the hospital. 17,638 of these patients (4.1%) died during the hospital admit. Inpatient and ED charges increased during the period of the study, from a median of $20,000 (interquartile range [IQR] $25,000) to $24,000 (IQR $27,000) (P<0.01). LOS remained constant at a median of 5 days (IQR 5 days) for this period. Factors associated with an increased risk of hospital admission included female sex, a comorbid burden of ≥3 (aOR 8.25 95% CI 7.89 – 8.62), age ≥65 years (aOR 3.13 95% CI 2.95 – 3.32) and presentation to a metropolitan facility (aOR 2.77 95% CI 2.69 – 2.85). Much smaller risks were associated with female gender (aOR 1.12 95%CI 1.09 – 1.15), Medicaid or Medicare insurance (aOR 1.21 95% CI 1.18 – 1.25), and presentation to a facility in the Southern region of the United States (aOR 1.06 95% CI 1.02 – 1.09). Conclusion: CDI related ED visits represent a considerable burden on the healthcare system in the United States. Additionally, an increasing trend in the incidence of these cases was observed for the years 2006–2010.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: We investigated the volume of endoscopic retrograde cholangiopancreatographies (ERCPs) performed in hospitalized children in the United States utilizing a nationwide healthcare administrative database for the years 2000 to 2009. 22,153 cases of ERCP were identified: 6,372 diagnostic and 17,314 therapeutic (1,533 cases were recorded as undergoing both types during a single hospitalization). The number of ERCPs increased from 5,337 to 6,733 per year; diagnostic ERCPs decreased 43% and therapeutic increased 69% (significant decreasing trends for diagnostic and increasing for therapeutic ERCPs, P < 0.001 for each analysis). Our results define a recent increase in the utilization of therapeutic ERCPs in hospitalized children.
    Journal of pediatric gastroenterology and nutrition 02/2014; · 2.18 Impact Factor
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    ABSTRACT: Abstract Objective: To investigate the epidemiology of GI bleeding in hospitalized children in the United States. Methods: Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the year 2009. The data were weighted to generate national-level estimates. Results: There were 23,383 pediatric discharges with a diagnosis of GI bleeding accounting for 0.5% of all discharges. Children with a GI bleed as compared to those without were more likely to be male (54.5% vs. 45.8%; P < 0.001), older (children ≥ 11 years; 50.8% vs. 38.7%; P < 0.001), and admitted to a teaching hospital (70.5% vs. 56.4%; P < 0.001). Children 11-15 years of age had the highest incidence of GI bleeding (84.2 per 10,000 discharges) and children less than 1 year of age the lowest (24.4 per 10,000 discharges). The highest incidence of GI bleeding was attributable to cases coded as blood in stool (17.6 per 10,000 discharges) followed by hematemesis (11.2 per 10,000 discharges). Those with a GI bleed had a higher co-morbid burden (12.3% vs. 2.3%; P < 0.001) and severity of illness (40.1% vs. 14.5%; P < 0.001). The highest mortality rates associated with GI bleeding were observed in cases with intestinal perforation (8.7%) and esophageal perforation (8.4%). GI bleeding was independently associated with a higher risk of mortality (aOR 1.68, CI 1.53-1.84). Conclusions: Our results describe the epidemiology of GI bleeding in hospitalized children within the United States. We found a substantial risk of mortality attributable to GI bleeding in this patient population. Our study is limited by the exclusion of non-hospitalized children, the reliance on ICD-9-CM codes and the absence of longitudinal follow up of patients.
    Current Medical Research and Opinion 01/2014; · 2.37 Impact Factor
  • Current Medical Research and Opinion 01/2014; · 2.37 Impact Factor
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    ABSTRACT: Single-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States. We used the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions. We identified 55,012 cases of AP in hospitalized children (1-20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78-0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40-2.46), and higher charges (aOR 1.62, 95% CI, 1.59-1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP. These results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity.
    PLoS ONE 01/2014; 9(5):e95552. · 3.53 Impact Factor
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    ABSTRACT: The incidence and prevalence of pediatric inflammatory bowel disease (IBD) seems to be increasing in North America and Europe. Our objective was to evaluate hospitalization rates in children with IBD in the United States during the decade 2000 to 2009. We analyzed cases with a discharge diagnosis of Crohn disease (CD) and ulcerative colitis (UC) within the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality. We identified 61,779 pediatric discharges with a diagnosis of IBD (CD, 39,451 cases; UC, 22,328 cases). The number of hospitalized children with IBD increased from 11,928 to 19,568 (incidence, 43.5-71.5 cases per 10,000 discharges per year; P < 0.001). For CD, the number increased from 7757 to 12,441 (incidence, 28.3-45.0; P < 0.001) and for UC, 4171 to 7127 (15.2-26.0; P < 0.001). Overall, there was a significant increasing trend for pediatric hospitalizations with IBD, CD, and UC (P < 0.001). In addition, there was an increase in IBD-related complications and comorbid disease burden (P < 0.01). There was a significant increase in the number and incidence of hospitalized children with IBD in the United States from 2000 to 2009.
    Journal of Investigative Medicine 06/2013; · 1.50 Impact Factor
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    ABSTRACT: Abstract Objective: To provide a comprehensive review of the literature as it relates to diarrhea in solid organ transplant (SOT) recipients. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis and management of diarrhea in SOT recipients and discuss recent advances and challenges. Methods: Two investigators conducted independent literature searches using PubMed, Web of Science, and Scopus until January 1st, 2013. All databases were searched using a combination of the terms diarrhea, solid organ transplant, SOT, transplant associated diarrhea, and transplant recipients. Articles that discussed diarrhea in SOT recipients were reviewed and relevant cross references also read and evaluated for inclusion. Selection bias could be a possible limitation of the approach used in selecting or finding articles for this article. Findings: Posttransplant diarrhea is a common and distressing occurrence in patients, which can have significant deleterious effects on the clinical course and well-being of the organ recipient. A majority of cases are due to infectious and drug-related etiologies. However, various other etiologies including inflammatory bowel disease must be considered in the differential diagnosis. A step-wise, informed approach to posttransplant diarrhea will help the clinician achieve the best diagnostic yield. The use of diagnostic endoscopy should be preceded by exclusion of an infectious or drug-related cause of diarrhea. Empiric management with antidiarrheal agents, probiotics, and lactose-free diets may have a role in managing patients for whom no cause can be determined even after an extensive investigation. Conclusions: Physicians should be familiar with the common etiologies that result in posttransplant diarrhea. A directed approach to diagnosis and treatment will not only help to resolve the diarrhea but also prevent potentially life-threatening consequences including loss of the graft as well. Prospective studies are required to determine the etiology of posttransplant diarrhea in different clinical and geographic settings.
    Current Medical Research and Opinion 06/2013; · 2.37 Impact Factor
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    Journal of clinical gastroenterology 06/2013; · 2.21 Impact Factor
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    ABSTRACT: Abstract Objective: To provide a comprehensive review of the literature relating to Clostridium difficile (C. difficile) infection (CDI) in the pediatric population. Methods: Two investigators conducted independent searches of PubMed, Web of Science, and Scopus until March 31st, 2013. All databases were searched using the terms Clostridium difficile, CDI, CDAD, antibiotic associated diarrhea, C. difficile in combination with Pediatric and Paediatric. Articles which discussed pediatric CDI were reviewed and relevant cross references also read and evaluated for inclusion. Selection bias could be a possible limitation of this approach. Findings: There is strong evidence for an increased incidence of pediatric CDI. Increasingly, the infection is being acquired from the community, often without a preceding history of antibiotic use. The severity of the disease has remained unchanged. Several medical conditions may be associated with the development of pediatric CDI. Infection prevention and control with antimicrobial stewardship are of paramount importance. It is important to consider the age of the child while testing for CDI. Traditional therapy with metronidazole or vancomycin remains the mainstay of treatment. Newer antibiotics such as fidaxomicin appear promising especially for the treatment of recurrent infection. Conservative surgical options may be a life-saving measure in severe or fulminant cases. Conclusions: Pediatric providers should be cognizant of the increased incidence of CDI in children. Early and judicious testing coupled with the timely institution of therapy will help to secure better outcomes for this disease.
    Current Medical Research and Opinion 05/2013; · 2.37 Impact Factor
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    ABSTRACT: OBJECTIVES: Antibiotic exposure is the most important risk factor for Clostridium difficile infection (CDI). Most evaluations of antimicrobial risk factors have been conducted in healthcare settings. The objective of this meta-analysis was to evaluate the association between antibiotic exposure and community-associated CDI (CA-CDI) (i.e. symptom onset in the community with no healthcare facility admission within 12 weeks) and to determine the classes of antibiotics posing the greatest risk. METHODS: We searched four electronic databases for subject headings and text words related to CA-CDI and antibiotics. Studies that investigated the risk of CA-CDI associated with antibiotic usage were considered eligible. Data from the identified studies were combined using a random-effects model and ORs were calculated. RESULTS: Of 910 citations identified, eight studies (n = 30 184 patients) met our inclusion criteria. Antibiotic exposure was associated with an increased risk of CA-CDI (OR 6.91, 95% CI 4.17-11.44, I(2) = 95%). The risk was greatest with clindamycin (OR 20.43, 95% CI 8.50-49.09) followed by fluoroquinolones (OR 5.65, 95% CI 4.38-7.28), cephalosporins (OR 4.47, 95% CI 1.60-12.50), penicillins (OR 3.25, 95% CI 1.89-5.57), macrolides (OR 2.55, 95% CI 1.91-3.39) and sulphonamides/trimethoprim (OR 1.84, 95% CI 1.48-2.29). Tetracyclines were not associated with an increased CDI risk (OR 0.91, 95% CI 0.57-1.45). CONCLUSIONS: Antibiotic exposure was an important risk factor for CA-CDI, but the risk was different amongst different antibiotic classes. The risk was greatest with clindamycin followed by fluoroquinolones and cephalosporins, whereas tetracyclines were not associated with an increased risk.
    Journal of Antimicrobial Chemotherapy 04/2013; · 5.34 Impact Factor
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    ABSTRACT: To determine whether the incidence of Clostridium difficile infection (CDI) continues to increase in hospitalized pediatric patients, we evaluated data from a United States national inpatient database. For the period of 2003 to 2009, we found an increasing trend in the incidence of CDI. These data suggest greater effort be given to prevent and treat this infection in children.
    The Pediatric Infectious Disease Journal 03/2013; · 3.14 Impact Factor
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    ABSTRACT: BACKGROUND:: Children with inflammatory bowel disease (IBD), similar to adults, are at increased risk of acquiring a Clostridium difficile infection (CDI). Our objective was to characterize the health care burden associated with CDI in hospitalized pediatric patients with IBD. METHODS:: We extracted and analyzed cases with a discharge diagnosis of IBD or CDI from the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database. RESULTS:: In our primary analysis, we evaluated pediatric cases with a principal diagnosis of IBD or CDI. For the year 2009, we identified 12,610 weighted cases with IBD of which 3.5% had CDI. In children with IBD, CDI was independently associated with lengthier hospital stays (8.0 versus 6.0 days; adjusted regression coefficient, 2.1 days; 95% confidence interval [CI], 1.4-2.8), higher charges ($45,126 versus $34,703; adjusted regression coefficient, $11,506; 95% CI, 6192-16,820), and greater need for parenteral nutrition (15.9% versus 12.1%; adjusted odds ratio, 1.5; 95% CI, 1.1-2.0) and blood transfusion (17.7% versus 9.8%; adjusted odds ratio, 1.8; 95% CI, 1.4-2.4). There were no deaths. We made similar observations in a subanalysis of cases with principal or secondary diagnoses of IBD or CDI. The incidence of CDI in patients with IBD increased between 2000 and 2009 from 21.7 to 28.0 cases per 1000 IBD cases per year (P < 0.001). There was a significant increase in CDI complicating ulcerative colitis (28.1 versus 42.2, P < 0.001) but not for Crohn's disease (18.3 versus 20.3). CONCLUSIONS:: CDI represents a significant health care burden in hospitalized children with IBD.
    Inflammatory Bowel Diseases 03/2013; · 5.12 Impact Factor
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    ABSTRACT: BACKGROUND AND AIM: Proton pump inhibitors (PPI) and H(2) -receptor antagonists (H(2) RA) are frequently prescribed in hospitalized patients with cirrhosis. There are conflicting reports regarding the role of acid suppressive therapy in predisposing hospitalized patients with cirrhosis to spontaneous bacterial peritonitis (SBP).The aim of this meta-analysis was to evaluate the association between acid-suppressive therapy and the risk of SBP in hospitalized patients with cirrhosis. METHODS: We searched MEDLINE and 4 other databases for subject headings and text words related to SBP and acid-suppressive therapy. All observational studies that investigated the risk of SBP associated with PPI/H2RA therapy and utilized SBP as an endpoint were considered eligible. Data from the identified studies were combined by means of a random-effects model and odds ratios (ORs) were calculated. RESULTS: Eight studies (n=3,815 patients) met inclusion criteria. The risk of hospitalized cirrhotic patients developing SBP increased when using acid-suppressive therapy. The risk was greater with PPI therapy (n= 3,815; OR 3.15, 95% CI 2.09-4.74) as compared to those on H2RA therapy (n=562; OR 1.71, 95% CI 0.97- 3.01). CONCLUSIONS: Pharmacologic acid-suppression was associated with a greater risk of SBP in hospitalized patients with cirrhosis. Cirrhotic patients receiving a PPI have approximately 3 times the risk of developing SBP compared to those not receiving this medication. Prospective studies may help clarify this relationship and shed light on the mechanism(s) by which acid-suppressive therapy increases the risk of SBP in hospitalized patients with cirrhosis.
    Journal of Gastroenterology and Hepatology 11/2012; · 3.33 Impact Factor
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    ABSTRACT: Dear Editor: We recognize the concerns raised by Drs Mahady and Webster in their letter to the editor. We agree that quality appraisal of individual studies is indeed important for any meta-analysis, and that the validity of the summary estimates depends on the quality of the included studies. We have now used the Newcastle–Ottawa scale1 to evaluate the 30 studies included in our original meta-analysis. When only high quality studies (score �7, n � 25) were analyzed separately, proton pump inhibitor (PPI) therapy continued to be associated with a 2-fold increase in risk for Clostridium difficile infection (odds ratio (OR), 2.24; 95% confidence interval [CI], 1.87–2.69), and high heterogeneity persisted.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 09/2012; 10(9):1057-1058. · 5.64 Impact Factor
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    ABSTRACT: Abstract Background: The incidence and severity of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is increasing. CDI is diagnosed by toxin enzyme immunoassay (EIA) or real-time polymerase chain reaction (PCR) performed on stool samples. An earlier study evaluating EIA in IBD patients with CDI suggested that more than one stool sample be tested to increase diagnostic yield. We investigated whether repeat stool testing improves diagnostic accuracy for CDI in hospitalized IBD patients compared to hospitalized patients with CDI and no IBD. Methods: We performed retrospective data analysis from January 2005-May 2011 on 63,086 hospitalized patients who were tested for CDI using EIA or PCR. Of these, 2579 patients had IBD. Transition probabilities were calculated based on results from repeated tests. Results: Inclusive of all inpatients tested for CDI, 56,583 were tested using toxin EIA and 6503 were tested using PCR. In patients with no IBD, the first stool sample tested was positive in 90% and 94% with EIA and PCR respectively. In IBD patients tested using EIA, 101 were diagnosed with CDI. The first stool sample tested was positive in 81% of patients. Successive second and third stool samples yielded additional 14% and 5% CDI positive IBD patients. Conclusions: Approximately one in five IBD patients with CDI required repeat testing to yield a positive result with EIA. There are minimal diagnostic gains of repeat testing by EIA or PCR in patients without IBD. We recommend repeat stool testing for CDI when using EIA to increase diagnostic yield in IBD patients.
    Current Medical Research and Opinion 08/2012; 28(9):1553-60. · 2.37 Impact Factor
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    ABSTRACT: Diarrhea is a frequent and potentially severe complication in solid organ transplant (SOT) recipients. One of the most common infectious etiologies of diarrhea in these patients is Clostridium difficile. Our objective was to investigate the association of C. difficile infection (CDI) with the outcomes of hospitalized SOT patients. We extracted all adult cases with discharge diagnoses of SOT or CDI from the United States Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2009 database. We collected outcome variables (mortality, length of hospital stay [LOS], hospitalization charges, complications of the transplanted organ, and colectomy), demographic information, and comorbidity data for each of the cases. The data were evaluated using univariate and multiple variable regression analyses. We identified 49,198 cases with SOT of which 2.7% had CDI. Univariate comparisons of cases with SOT + CDI to those with SOT-only revealed significant differences in the evaluated outcomes including in-hospital mortality (7.4% vs. 2.4%, P < 0.001), LOS (median 9 days vs. 4 days, P < 0.001), charges (median $53,808 vs. $31,488, P < 0.001), organ complications (38.1% vs. 33.9%, P < 0.001), and colectomy (1.1% vs. 0.3%, P < 0.001). Using multiple variable regression analyses, in the SOT cohort (SOT-only and SOT + CDI), CDI was independently associated with greater mortality (adjusted odds ratio [aOR] 2.48, 95% confidence interval [CI] = 2.22, 2.76, P < 0.001), longer LOS (difference 9.6 days, 95% CI = 9.3, 9.9, P < 0.001), higher charges (difference $69,647, 95% CI = $66,190, $73,104, P < 0.001), more complications of the transplanted organ (aOR 1.36, 95% CI = 1.28, 1.44, P < 0.001), and increased need for colectomy (aOR 3.10, 95% CI = 2.35, 4.08, P < 0.001). Our results demonstrate that CDI is associated with overall significantly worse outcomes in hospitalized patients with SOT.
    Transplant Infectious Disease 06/2012; 14(5):540-7. · 1.98 Impact Factor

Publication Stats

182 Citations
96.96 Total Impact Points

Institutions

  • 2012–2013
    • Case Western Reserve University
      • Department of Medicine (University Hospitals Case Medical Center)
      Cleveland, Ohio, United States
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2010–2013
    • University of Oklahoma Health Sciences Center
      • Department of Pediatrics
      Oklahoma City, OK, United States
  • 2011–2012
    • Barrow Neurological Institute
      Phoenix, Arizona, United States
  • 2009–2011
    • Louisiana State University Health Sciences Center Shreveport
      • School of Medicine
      Shreveport, Louisiana, United States
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Medicine
      Baton Rouge, LA, United States