{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T23:43:47Z","timestamp":1724715827373},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T00:00:00Z","timestamp":1500940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T00:00:00Z","timestamp":1500940800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"name":"Au5","award":["89L2TR000160 KL2 TR000160-05","ME-1310-07682","R01 HS022694-01A1"],"award-info":[{"award-number":["89L2TR000160 KL2 TR000160-05","ME-1310-07682","R01 HS022694-01A1"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>C. difficile<\/jats:italic> (CDI) has surpassed methicillin\u2010resistant staph aureus as the most common nosocomial infection with recurrence reaching 30% and the elderly being disproportionately affected. We hypothesized that post\u2010discharge antibiotic therapy for continued CDI treatment reduces readmissions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>We queried a 5% random sample of Medicare claims (2009\u20132011\u00a0Part A and Part D; <jats:italic>n<\/jats:italic> = 864,604) for hospitalizations with primary or secondary diagnosis of CDI. We compared demographics, comorbidities, and post\u2010discharge CDI treatment (no CDI treatment, oral metronidazole only, oral vancomycin only, or both) between patients readmitted with a primary diagnosis of CDI within 90\u00a0days and patients not readmitted for any reason using univariate tests of association and multivariable models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 7042 patients discharged alive, 945 were readmitted \u226490\u00a0days with CDI (13%), while 1953 were not readmitted for any reason (28%). Patients discharged on dual therapy had the highest rates of readmission (50%), followed by no post\u2010discharge CDI treatment (43%), vancomycin only (28%), and metronidazole only (19%). Patients discharged on only metronidazole (OR 0.28) or only vancomycin (OR 0.42) had reduced odds of 90\u2010day readmission compared to patients discharged on no CDI treatment. Patients discharged on dual therapy did not vary in odds of readmission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Thirteen percent of patients discharged with CDI are readmitted within 90\u00a0days. Patients discharged with single\u2010drug therapy for CDI had lower readmission rates compared to patients discharged on no ongoing CDI treatment suggesting that short\u2010term monotherapy may be beneficial in inducing eradication and preventing relapse. Half of patients requiring dual therapy required readmission, suggesting patients with symptoms severe enough to warrant discharge on dual therapy may benefit from longer hospitalization.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-017-4139-8","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T13:24:43Z","timestamp":1500989083000},"page":"246-253","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Post\u2010hospitalization Treatment Regimen and Readmission for <i>C. difficile<\/i> Colitis in Medicare Beneficiaries"],"prefix":"10.1002","volume":"42","author":[{"given":"Charles M.","family":"Psoinos","sequence":"first","affiliation":[{"name":"Department of Surgery University of Massachusetts Medical School Room S3\u2010731, 55 Lake Avenue North 01655 Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney E.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Massachusetts Medical School Room S3\u2010731, 55 Lake Avenue North 01655 Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Didem","family":"Ayturk","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Massachusetts Medical School Room S3\u2010731, 55 Lake Avenue North 01655 Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick A.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Massachusetts Medical School Room S3\u2010731, 55 Lake Avenue North 01655 Worcester MA USA"},{"name":"Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heena P.","family":"Santry","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Massachusetts Medical School Room S3\u2010731, 55 Lake Avenue North 01655 Worcester MA USA"},{"name":"Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,25]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/659156"},{"issue":"276","key":"e_1_2_8_3_2","first-page":"e271","article-title":"A case\u2010control study of community\u2010associated Clostridium difficile infection: no role for proton pump inhibitors","volume":"124","author":"Naggie S","year":"2011","journal-title":"Am J Med"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1086\/516277"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.01.053"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102014\u2010005665"},{"issue":"303","key":"e_1_2_8_7_2","first-page":"6","article-title":"Antibiotic\u2010associated colitis caused by Clostridium difficile: relapse and risk factors","volume":"144","author":"Young GP","year":"1986","journal-title":"Med J Aust"},{"issue":"334","key":"e_1_2_8_8_2","first-page":"9","article-title":"Clinical practice. 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