Clostridium difficile infection is associated with poor outcomes in end-stage renal disease.
OBJECTIVE
To investigate the association of Clostridium difficile infection (CDI) with the outcomes of hospitalized patients with end-stage renal disease (ESRD).


METHODS
We extracted all adult cases with a discharge diagnosis of ESRD or CDI from the United States Nationwide Inpatient Sample 2009 database. Outcome variables (mortality, length of hospital stay [LOS], and hospitalization charges), demographic information, and comorbidity data were collected. Data were evaluated by univariate and multiple regression analyses.


RESULTS
We identified 184,139 cases with ESRD of which 2.8% had CDI. Comparison of patients with ESRD + CDI to those with only ESRD revealed in-hospital mortality (13.2% vs 5.3%; P < 0.001), LOS (17.3 vs 7.1 days; P < 0.001), and charges ($124,846 vs $56,663; P < 0.001) to be more than 2-fold greater. In the ESRD cohort (ESRD only and ESRD + CDI), CDI was independently associated with greater mortality (adjusted odds ratio, 2.15; 95% CI, 2.07-2.24; P < 0.001), longer LOS (mean difference, 9.4 days; 95% CI, 9.2-9.5; P < 0.001), and higher charges (mean difference, $62,824; 95% CI, 61,615-64,033; P < 0.001).


CONCLUSIONS
Clostridium difficile infection is associated with significantly worse outcomes in hospitalized patients with ESRD.
Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Chaitanya
C
Pant
Abhishek
A
Deshpande
Michael P
MP
Anderson
Thomas J
TJ
Sferra
D000368:Aged; D016360:Clostridioides difficile / Q000502:physiology*; D003015:Clostridium Infections / Q000150:complications* / Q000382:microbiology* / Q000401:mortality; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000382:microbiology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology