Class of 2012 Abstract / Specific Aims: To identify the number of Clostridium difficile-associated disease (CDAD) cases in hospitalized oncology patients between 2005 and 2009. To identify the occurrence of mortality, comorbidities, and the amount of hospital charges in this patient population. Predictive variables for mortality and hospital charges were also identified. Methods: Data retrieved from the Nationwide Inpatient Sample were used to retrospectively identify the number of CDAD cases in hospitalized oncology patients, the occurrence of mortality and comorbidities, and the amount of hospital charges incurred between 2005 and 2009. Multivariate logistic regression was used to identify predictors of mortality and a lognormal regression was used to identify predictors of inpatient charges. Main Results: From 2005 to 2009, we identified 210,449 cases of CDAD in hospitalized adult patients with cancer. Total inpatient charges for all CDAD cases over the five-year period exceeded 18 billion dollars. The percentage of cases that resulted in death was 13%. Variables that were found to be predictors of mortality included increased age (OR 1.019, CI 1.018-1.020), chronic pulmonary disease (OR 1.231, CI 1.191-1.272), coagulopathy (OR 2.085, CI 2.011-2.162), liver disease (OR 1.159, CI 1.072-1.253), fluid and electrolyte disorders (OR 1.561, CI 1.518-1.605), renal failure (OR 1.405, CI 1.349-1.462), and weight loss (OR 1.408, CI 1.362-1.456)(all p<.001). Conclusions: This study identified a large number of CDAD cases in hospitalized adult cancer patients. Several factors that appeared to be predictive of mortality and inpatient charges were also identified, which may be useful knowledge for clinicians who need to identify at-risk patients.

Introduction: Recently, Clostridium difficile has garnered both national and international attention, occurring with greater frequency, severity and resistance to standard treatments. In 2001, Clostridium difficile-associated disease, CDAD, became epidemic and its rate doubled from 2000 to 2003. As a substantial cause of healthcare-associated morbidity, CDAD is no longer just a pharmacotherapy nuisance. Specifically, the objectives of this research are to determine the incidence of both primary and secondary cases of CDAD among patients in the UHC database, determine how many primary cases had previous admissions with secondary cases of CDAD, and determine how many primary cases go on to be readmitted as primary or secondary cases.Methods: This cross-sectional study used the dataset from the University HealthSystem Consortium (UHC) covering the first quarter of 2002 through the second quarter of 2006, to identify the incidence of primary and secondary CDAD within hospitals participating in the UHC's Clinical Resource Manager (CRM) program. The UHC-CRM database was used to provide epidemiologic data in regards to CDAD cases, hospital-wide variables and patient characteristics. The data was analyzed using SAS statistical software.Results: During the time period studied, a total of 17,636 CDAD cases were identified out of 2,805,901 total hospital discharges. Of those, 80.4% or 14,178 fit the definition of primary with 3,454 cases labeled as secondary. The mean discharge rate of primary CDAD cases, per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 3.14 (SD 2.33) to 6.72 (SD 4.0). The mean incidence of secondary CDAD per 1,000 adult discharges among CRM-participating hospitals per quarter, ranged from 0.79 (SD 0.74) to 1.59 (SD 0.86). The mean discharge rate of all CDAD cases, per 1,000 (adult discharges) among CRM-participating hospitals per quarter, ranged from 3.93 (SD 3.04) to 8.11 (SD 4.52). The rate of CDAD case discharges shows an increasing trend, more than doubling from 2002 to 2006. Among previous primary CDAD admissions, 7.75% were readmitted as a primary CDAD cases (p-value Conclusions: CDAD cases are on the rise, with all CDAD cases diagnosed on discharge from doubling from 2002 to 2006. There is no current national surveillance system for tracking CDAD cases. This study begins to shed light on the increasing incidence of CDAD cases within the hospital setting. By providing a baseline, future research can use this information to make more extensive tracking and surveillance systems for CDAD cases.