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Abstract: Poster Presentations |

RATES AND OUTCOMES OF CLOSTRIDIUM DIFFICILE-ASSOCIATED DISEASE (CDAD) AMONG PATIENTS ON PROLONGED ACUTE MECHANICAL VENTILATION (PAMV) FREE TO VIEW

Marya D. Zilberberg, MD*; Brian H. Nathanson, PhD; Thomas L. Higgins, MD; Andrew F. Shorr, MD; Marin H. Kollef, MD
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University of Massachusetts, Amherst, MA


Chest


Chest. 2008;134(4_MeetingAbstracts):p50001. doi:10.1378/chest.134.4_MeetingAbstracts.p50001
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Abstract

PURPOSE: Patients on PAMV, though comprising 1/3 of all MV patients consume 2/3 of all the resources allocated to MV [1], and their numbers are projected to double by year 2020 [2]. By virtue of their prolonged hospital length of stay (LOS, median 17 days [1]), they are subject to such nosocomial infections as CDAD, whose incidence and age-adjusted case fatality rate have doubled between 2000 and 2005 [3]. We examined the rates and outcomes of CDAD among adult PAMV patients.

METHODS: We performed a cross-sectional analysis of 2005 data from the Health Care Utilization Project (HCUP)/Nationwide Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality (AHRQ). PAMV and CDAD were identified using the ICD-9-CM codes 96.72 and 008.45, respectively.

RESULTS: Among 64,910 adult PAMV discharges in 2005, 3,468 (5.34%) had a concurrent diagnosis of CDAD. CDAD+ discharges were older (66.7+/−15.9 vs. 63.7+/−16.9 years, p<0.001), and more likely to be admitted from a long-term facility (9.9% vs. 5.2%, p<0.001) than CDAD-. While hospital mortality did not differ among PAMV discharges by CDAD status (32.6% CDAD+ and 33.0% CDAD-, p=0.598), the presence of CDAD was associated with significantly higher mean unadjusted hospital LOS (32.37+/−28.47 days CDAD+ and 22.18+/−19.53 days CDAD-, p<0.001), and charges ($211,322+/-$175,330 CDAD+ and $162,380+/-$145515 CDAD-, p<0.001).

CONCLUSION: PAMV patients have an order of magnitude higher risk of CDAD than other hospitalized patients [3]. While not affecting mortality, concurrent CDAD infection is associated with increased hospital LOS and costs.

CLINICAL IMPLICATIONS: PAMV population is an attractive target for aggressive preventive CDAD measures.[1]Zilberberg et al. Crit Care Med 2008:36;724–30[2]Zilberberg et al. Crit Care Med 2008 Apr 21; [Epub ahead of print][3]Zilberberg et al. Emerg Infect Dis 2008, in press.

DISCLOSURE: Marya Zilberberg, None.

Tuesday, October 28, 2008

1:00 PM - 2:15 PM


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