Showing papers by "Richard S. Johannes published in 2015"
TL;DR: Using clinical parameters available at the time of admission, this logistic regression model demonstrated good predictive ability, and it may have utility as an early risk identification tool for HO-CDI preventive interventions and outcome comparisons.
Abstract: OBJECTIVE To predict the likelihood of hospital-onset Clostridium difficile infection (HO-CDI) based on patient clinical presentations at admission DESIGN Retrospective data analysis SETTING Six US acute care hospitals PATIENTS Adult inpatients METHODS We used clinical data collected at the time of admission in electronic health record (EHR) systems to develop and validate a HO-CDI predictive model. The outcome measure was HO-CDI cases identified by a nonduplicate positive C. difficile toxin assay result with stool specimens collected >48 hours after inpatient admission. We fit a logistic regression model to predict the risk of HO-CDI. We validated the model using 1,000 bootstrap simulations. RESULTS Among 78,080 adult admissions, 323 HO-CDI cases were identified (ie, a rate of 4.1 per 1,000 admissions). The logistic regression model yielded 14 independent predictors, including hospital community onset CDI pressure, patient age ≥65, previous healthcare exposures, CDI in previous admission, admission to the intensive care unit, albumin ≤3 g/dL, creatinine >2.0 mg/dL, bands >32%, platelets ≤150 or >420 109/L, and white blood cell count >11,000 mm3. The model had a c-statistic of 0.78 (95% confidence interval [CI], 0.76–0.81) with good calibration. Among 79% of patients with risk scores of 0–7, 19 HO-CDIs occurred per 10,000 admissions; for patients with risk scores >20, 623 HO-CDIs occurred per 10,000 admissions (P<.0001). CONCLUSION Using clinical parameters available at the time of admission, this HO-CDI model demonstrated good predictive ability, and it may have utility as an early risk identification tool for HO-CDI preventive interventions and outcome comparisons. Infect Control Hosp Epidemiol 2015;00(0):1–7
32 citations
TL;DR: The study by Di Bella et al demonstrates that at the cellular level hypoalbuminemia plays a role in the predisposition to CDI, due to compromising the protective properties of albumin.
Abstract: To the Editor—In their intriguing investigation, reported in “The protective role of albumin in Clostridium difficile infection: A step toward solving the puzzle,” Di Bella et al explored the cellular mechanism of the potential protective effect of albumin in C. difficile infection (CDI). Their findings deepen our understanding of the association between low albumin levels and increased risks for CDI. We applaud their effort. Previous epidemiological work has revealed that hypoalbuminemia is a robust independent risk factor for mortality for hospitalized patients across a spectrum of clinical categories. Our most recent CDI predictive model demonstrated that hypoalbuminemia is one of the independent risk factors that are associated with, or predictive of, hospital-onset CDI. The study by Di Bella et al demonstrates that at the cellular level hypoalbuminemia plays a role in the predisposition to CDI, due to compromising the protective properties of albumin. Future studies may further explore the mechanism of low albumin levels and other pathological manifestations.
2 citations