All-cause mortality in hospitalized patients with infectious diarrhea: Clostridium difficile versus other enteric pathogens in Austria from 2008 to 2010.
BACKGROUND
Clostridium difficile infection is the leading cause of gastroenteritis-associated deaths in the industrialized world, followed by infection with norovirus.


METHODS
Using a cohort study design, we compared 90 inpatients with diarrhea due to C. difficile infection (CDI) with 180 inpatients with diarrhea due to other infectious agents (including 55% with norovirus infection) with respect to complications and all-cause mortality. The effects of age, severity of underlying diseases and additional infections were assessed by stratified analyses.


RESULTS
Diarrhea recurrence occurred 8.9 (95%CI: 2.9-27.3) times more often in CDI independent of age and severity of comorbidities. The all-cause mortality in CDI patients pre-discharge and at 30 and 180 days, respectively, was 20.0%, 17.0% and 42.3% versus 7.2%, 6.7% and 22.5% in non-CDI diarrhea patients. Among those patients with low comorbidities, who were younger than 65 years and without additional infections, the all-cause pre-discharge, 30-day and 180-day mortality risks were significantly higher for the CDI diarrhea patients than the non-CDI diarrhea patients. This association was not observed among patients with an older age, more severe comorbidities or additional infections.


CONCLUSIONS
CDI results in higher all-cause mortality than diarrhea due to other infectious agents in younger patients with low comorbidities.
Austrian Agency for Health and Food Safety (AGES), Währingerstr. 25a, 1090 Vienna, Austria. Electronic address: daniela.schmid@ages.at.
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Schmid
Austrian Agency for Health and Food Safety (AGES), Währingerstr. 25a, 1090 Vienna, Austria. Electronic address: hwkuo119@hotmail.com.
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Kuo
Austrian Agency for Health and Food Safety (AGES), Währingerstr. 25a, 1090 Vienna, Austria. Electronic address: erica.simons@ages.at.
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Simons
Austrian Agency for Health and Food Safety (AGES), Währingerstr. 25a, 1090 Vienna, Austria. Electronic address: elisabeth.kanitz@ages.at.
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Kanitz
Kaiser Franz Josef-Hospital, Department for Infectious Diseases, Kundratstr. 3, 1010 Vienna, Austria. Electronic address: judith.wenisch@wienkav.at.
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Wenisch
Austrian Agency for Health and Food Safety (AGES), Währingerstr. 25a, 1090 Vienna, Austria. Electronic address: franz.allerberger@ages.at.
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Allerberger
Kaiser Franz Josef-Hospital, Department for Infectious Diseases, Kundratstr. 3, 1010 Vienna, Austria. Electronic address: christoph.wenisch@wienkav.at.
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Wenisch
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D003015:Clostridium Infections / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029322:Norovirus; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
Age; All-cause death; Clostridium difficile infection; Diarrhea; Underlying disease