title: All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study.
abstract: BACKGROUND
  Mortality among patients with Clostridium difficile infection (CDI) is high. Because of high age and multiple underlying diseases, CDI-related mortality is difficult to estimate. We estimated CDI-related mortality in an endemic situation, not influenced by outbreaks and consequently certain patients and C. difficile strains.
  
  
  METHODS
  Between 2006 and 2009, 13 Dutch hospitals included all hospitalized CDI patients. Nine hospitals individually matched each CDI patient to 2 control patients, based on ward and time of CDI hospitalization. Survival status was obtained via the Dutch Civil Registration System. Kaplan-Meier and Cox regression were used for survival analysis.
  
  
  RESULTS
  We identified 1366 patients with CDI (1.33 per 1000 admissions). All-cause mortality risk was 13% after 30 days and 37% after 1 year. The highest mortality was seen among elderly patients and patients with polymerase chain reaction ribotype 027. Three hundred seventeen CDI patients were matched to 317 patients without diarrhea and 232 patients with diarrhea, with a 30-day mortality risk of 5.4% and 8.6%, respectively. CDI patients had a 2.5-fold increased 30-day mortality rate compared to controls without diarrhea (hazard ratio 2.5 [95% confidence interval, 1.4-4.3]) when adjusted for age, sex, and underlying diseases. CDI-related death occurred mainly within 30 days after diagnosis.
  
  
  CONCLUSIONS
  Mortality among CDI patients is high, even in an endemic situation. Our results show that CDI is associated with to a 2.5-fold increase in 30-day mortality. This highlights the considerable disease burden and clinical impact of CDI, even in absence of an outbreak.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Marjolein P M
authors.initials: MP
authors.lastname: Hensgens
authors.forename: Abraham
authors.initials: A
authors.lastname: Goorhuis
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.forename: Birgit H B
authors.initials: BH
authors.lastname: van Benthem
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D016360:Clostridioides difficile; D015331:Cohort Studies; D003644:Death Certificates; D003967:Diarrhea / Q000382:microbiology / Q000401:mortality*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012306:Risk