Tuesday, September 3, 2013

Cohorting Patients with C.difficile Infection

Patients infected with Clostridium difficile are placed in contact isolation precautions in an single occupancy room. Is there any danger to cohorting patients with  Clostridium difficile infection (CDI)?

Here is a recent publication in he Journal of Hospital Infection assessing the risk of recurrent disease in patients cohorted with Clostridium difficile associated diarrhea.

In a UK hospital, 138 t (55.6%) CDI patients were admitted to a cohort ward. These patients were more likely to have severe CDI (odds ratio: 1.95; 95% confidence interval: 1.10–3.46; P = 0.022) and receive vancomycin (1.59; 0.94–2.68; P = 0.083) than patients who were not cohorted. Twenty-six patients (10.5%) suffered recurrence (21 cohorted and five not cohorted). Urinary infection on admission (5.16; 2.10–12.64;P < 0.001), cohorting (3.77; 1.37–10.35; P = 0.01) and concomitant antibiotics (2.07; 0.91–4.72; P = 0.083) were associated with increased risk of recurrence. On multivariate analysis, cohorting (3.94; 1.23–12.65;P = 0.021) and urinary infection (4.27; 1.62–11.24; P = 0.003) were significant predictors of recurrence.

Although there are adverse consequences of isolation, cohorting of patients with CDI is not prudent.  The benefits outweigh the risk.

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