Rohit Das

Albert Einstein College of Medicine, New York City, NY, United States

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Publications (8)76.82 Total impact

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    ABSTRACT: OBJECTIVES:Over the past decade, the epidemiology of Clostridium difficile infection (CDI) has shown a remarkable increase in incidence with an associated increase in severity. This study was designed to compare the demographics, medication exposure, evaluation, treatment patterns, and outcomes of patients with CDI in two different time periods: 2006-2008 and 2009-2011. We hypothesized that mortality is decreasing with increasing appropriateness of medical management.METHODS:We retrospectively identified consecutive patients admitted to Montefiore Medical Center between 1/1/2006 and 12/31/2011 with symptomatic diarrhea and a positive C. difficile toxin assay. The cohort was subdivided into those diagnosed in 2006-2008 (CDI 06-08) and 2009-2011 (CDI 09-11). We obtained key parameters at the time of diagnosis including demographics, medication exposure, medical comorbidities, laboratory data, CDI evaluation, and various outcome measures. We created a subcohort for each time frame of patients diagnosed with severe CDI defined by white blood cell count (WBC) >15,000 cells/μl and albumin <3.0 g/dl and made the same comparisons as for the overall cohort. The two cohorts were compared using SPSS (16.0).RESULTS:Cohorts and the number of patients who met criteria for inclusion were as follows: CDI 06-08 (n=1189), CDI 09-11 (n=1,907), severe CDI 06-08 (n=243), and severe CDI 09-11 (n=382). CDI 09-11 patients were older (P=0.01) and had higher Charlson comorbidity scores (P=0.02) than did those in the CDI 06-08 cohort. There were no significant demographic differences in the severe cohort. For both the overall and severe cohorts, there was more macrolide exposure before diagnosis with CDI and lower rates of quinolone exposure in the more recent era. The disease process also appeared less severe in the CDI 09-11 cohort with lower peak WBC during admission and at diagnosis. Treatment patterns appeared more aggressive during the more recent time frame, with shorter durations of oral metronidazole (P<0.001), longer durations of IV metronidazole (P=0.04), more frequent use of vancomycin as the sole therapy (P<0.001), more frequent switching from metronidazole to vancomycin (P<0.001), and less frequent exposure to any metronidazole throughout treatment (P<0.001) in the overall cohort. The 30-day mortality decreased significantly in both the overall (17.1 vs. 13.1%, P<0.01) and the severe (31.3 vs. 23.3%, P<0.05) cohorts from CDI 06-08 to CDI 09-11, with mortality decreasing significantly in the 8th and 9th decades of life in the overall cohort and in the 8th, 9th, and 10th decades in the severe cohort.CONCLUSIONS:In an urban United States population, CDI 09-11 showed changes in medication exposures, less severe disease, and more aggressive management with better outcomes and decreased mortality compared with CDI 06-08. The most important factors associated with 30-day mortality in both an overall and severe CDI population include age, WBC, and albumin level at the time of diagnosis.Am J Gastroenterol advance online publication, 8 July 2014; doi:10.1038/ajg.2014.167.
    The American Journal of Gastroenterology 07/2014; · 9.21 Impact Factor
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    ABSTRACT: BACKGROUND:: Studies have suggested that colonic diverticulosis might increase the likelihood of repeat Clostridium difficile infection (CDI). Our study was designed to compare rates of repeat infection in patients with and without colon diverticula. METHODS:: Patients who had a positive C. difficile toxin assay and colonoscopic evidence of diverticulosis were classified as CDI and diverticulosis (CDI-D), whereas those with a positive toxin assay but no such colonoscopic evidence were classified as CDI and no diverticulosis (CDI-ND). Various clinical and epidemiologic factors were recorded for each patient. Primary outcomes were "relapse" (repeat CDI within 3 mo of initial infection) and "recurrent" infection (repeat CDI≥3 mo after initial infection). Secondary outcomes 30 days after diagnosis were mortality, intensive care unit transfer, and continuous hospitalization. RESULTS:: A total of 128 patients were classified as CDI-D, whereas 137 had CDI-ND. There were no significant differences between CDI-D and CDI-ND when comparing frequencies of repeat infection and its subclassifications, relapse or recurrence. There were, however, statistical associations seen between diverticulosis of the ascending colon and increased recurrence rates [hazard ratio (HR): 1.4±0.38, P<0.05] and decreased rates of relapse in diverticular disease of the descending (HR: 0.40±0.46, P<0.05), and sigmoid colon (HR: 0.39±0.49, P<0.05). The ascending colon association is limited by a small patient population. There were no significant differences in any of the 30-day outcomes including intensive care unit requirement, hospitalization stay, or mortality. CONCLUSIONS:: Patients with diverticular disease of the colon are not at increased risk of repeat CDI.
    Journal of clinical gastroenterology 02/2013; · 2.21 Impact Factor
  • Gastroenterology 01/2011; 140(5). · 12.82 Impact Factor
  • Gastroenterology 01/2011; 140(5). · 12.82 Impact Factor
  • Gastroenterology 05/2010; 138(5). · 12.82 Impact Factor
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    ABSTRACT: Glucocorticoids are commonly used to treat various illnesses in patients at risk for Clostridium difficile-associated disease (CDAD), but the effect of such immunosuppression on outcome has not been studied. We hypothesized that glucocorticoid use increases the risk of 30-day mortality in patients with CDAD. We identified consecutive inpatients from 1 January 2004 to 30 September 2008, who had a positive Clostridium difficile toxin assay and recorded their demography, glucocorticoid usage before CDAD diagnosis, 30-day mortality, Charlson comorbidity score, and pertinent laboratory data. Three cohorts were created: Group 1: CDAD (+) without glucocorticoid use, Group 2: CDAD (+) with glucocorticoid use, and Group 3: CDAD (-) with symptomatic diarrhea and receiving glucocorticoids. Groups 1, 2, and 3 consisted of 841, 285, and 898 patients, respectively. Significant multivariate predictors of short-term mortality were age in Group 1 (P<0.001); age (P=0.007), Charlson score (P=0.004), and an endocrine indication for glucocorticoid use (P<0.01) in Group 2; and age (P<0.001), sex, (P=0.02), Charlson score (P<0.001), weight-adjusted glucocorticoid dose (1.10+/-0.03), and prednisone use (P<0.01) in Group 3. When considering all patients with CDAD (Groups 1 and 2), the use of any glucocorticoid resulted in an increased mortality with a hazard ratio of 2.1+/-0.19 (P<0.001). Mortality rates were 9.6%, 19.3%, and 9.7% for Groups 1, 2, and 3 (P<0.001 for Groups 1 and 3 vs. Group 2), respectively. Through Kaplan-Meier survival analysis, comparing the three groups revealed that patients with CDAD who received glucocorticoids were at significantly increased risk of short-term mortality compared with the control groups (Groups 1 and 3, P<0.001). Mortality of patients with CDAD on glucocorticoids, regardless of the severity of CDAD, was significantly higher than the mortality of patients with CDAD not on glucocorticoids and those on glucocorticoids with symptomatic diarrhea and without C. difficile infection.
    The American Journal of Gastroenterology 04/2010; 105(9):2040-9. · 9.21 Impact Factor
  • Gastroenterology 05/2009; 136(5). · 12.82 Impact Factor
  • Gastrointestinal Endoscopy 04/2009; 69(5). · 4.90 Impact Factor