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Epidemiology, outcomes, and predictors of mortality in hospitalized adults with Clostridium difficile infection

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Abstract

Studies have demonstrated an increasing Clostridium difficile infection (CDI) incidence in hospitals and the community, with increasing morbidity and mortality. In this study, we analyzed data from the National Hospital Discharge Survey (NHDS) to evaluate CDI epidemiology, outcomes, and predictors of mortality in hospitalized adults. We identified cases of CDI (and associated comorbid conditions) from NHDS data from 2005 through 2009 using ICD-9 codes. Weighted univariate and multivariate analyses were performed to ascertain CDI incidence, associations between CDI and outcomes [length of stay (LOS), colectomy, all-cause in-hospital mortality, and discharge to a care facility], and predictors of all-cause in-hospital mortality. Of an estimated 162 million adult inpatients, 1.26 million (0.8 %) had CDI. The overall CDI incidence is 77.8/10,000 hospitalizations, with no statistically significant change over the study period. On multivariate analysis, after adjusting for age, gender, and comorbid conditions, CDI is an independent predictor of longer LOS (mean difference, 2.35 days), all-cause mortality [odds ratio (OR) 1.45], colectomy (OR 1.41), and discharge to a care facility (OR 2.12) (all P < 0.001). Elderly patients have a higher CDI incidence and worse outcomes than younger adults. The strongest predictors of all-cause mortality in patients with CDI include age 65 years or older, colectomy, and coagulation abnormalities. Despite stable CDI incidence and advances in management, CDI is associated with increased LOS, colectomy, all-cause in-hospital mortality, and discharge to a care facility in hospitalized, especially elderly, adults. Age older than 65 years should be added to the severity criteria for CDI.

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Abbreviations

CDI:

Clostridium difficile infection

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

LOS:

Length of stay

NHDS:

National Hospital Discharge Survey

OR:

Odds ratio

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Author information

Author notes

  1. Arjun Gupta

    Present address: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Sahil Khanna & Darrell S. Pardi

  2. Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA

    Arjun Gupta & Larry M. Baddour

  3. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

    Larry M. Baddour

Authors
  1. Sahil Khanna
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  2. Arjun Gupta
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  3. Larry M. Baddour
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  4. Darrell S. Pardi
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Corresponding author

Correspondence to Sahil Khanna.

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Conflict of interest

SK has served as a consultant to Cubist Pharmaceuticals (Now Merck) in the past and DSP is a consultant for Cubist Pharmaceuticals (Now Merck) and Seres Therapeutics, both related to C. difficile infection, but the relationship is unrelated to the work in this manuscript.

Statement of human and animal rights

This study was performed using available data from the National Hospital Discharge Survey. No identifiable patient level data was accessed. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was not required as the research was conducted using data collected by the National Hospital Discharge Survey (NHDS) which has a consent waiver. Data collected in the NHDS are consistent with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). No personally identifying information, such as patient's name, address, or Social Security number, is collected in the NHDS.

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Khanna, S., Gupta, A., Baddour, L.M. et al. Epidemiology, outcomes, and predictors of mortality in hospitalized adults with Clostridium difficile infection. Intern Emerg Med 11, 657–665 (2016). https://doi.org/10.1007/s11739-015-1366-6

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  • DOI: https://doi.org/10.1007/s11739-015-1366-6

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