The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis.
OBJECTIVE
To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis.


BACKGROUND
Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection.


METHODS
Retrospective cohort study.


METHODS
We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay.


METHODS
We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups.


RESULTS
Of 218,915 sepsis patients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDI patients than controls (25% vs 10%, P < 0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P < 0.001).


CONCLUSIONS
After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed.
Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, Masachusetts; Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
Tara
T
Lagu
Mihaela S
MS
Stefan
Sarah
S
Haessler
Thomas L
TL
Higgins
Michael B
MB
Rothberg
Brian H
BH
Nathanson
Nicholas S
NS
Hannon
Jay S
JS
Steingrub
Peter K
PK
Lindenauer
D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome