Clostridium difficile infection in patients hospitalized with type 2 diabetes mellitus and its impact on morbidity, mortality, and the costs of inpatient care.
OBJECTIVE
Type 2 diabetes mellitus (T2DM) is often complicated by infections leading to hospitalization, increased morbidity, and mortality. Not much is known about the impact of Clostridium difficile infection (CDI) on health outcomes in hospitalized patients with T2DM. We estimated the prevalence and temporal trends of CDI; evaluated the associations between CDI and in-hospital mortality, length of stay (LOS), and the costs of inpatient care; and compared the impact of CDI with that of other infections commonly seen in patients with T2DM.


METHODS
We conducted a cross-sectional analysis using data from the Nationwide Inpatient Sample among patients ⩾18years with T2DM and generalized linear regression was used to analyze associations and jointpoint regression for trends.


RESULTS
The prevalence of CDI was 6.8 per 1000 hospital discharges. Patients with T2DM and CDI had increased odds of in-hospital mortality (OR, 3.63; 95% CI 3.16, 4.17). The adjusted mean LOS was higher in patients with CDI than without CDI (11.9 vs. 4.7days). That translated to average hospital costs of $23,000 and $9100 for patients with and without CDI, respectively. The adjusted risk of mortality in patients who had CDI alone (OR 3.75; 95% CI 3.18, 4.41) was similar to patients who had CDI in addition to other common infections (OR 3.25; 95% CI 2.58, 4.10).


CONCLUSIONS
CDI is independently associated with poorer health outcomes in patients with T2DM. We recommend close surveillance for CDI in hospitalized patients and further studies to determine the cost effectiveness of screening for CDI among patients with T2DM.
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA; School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Titilope O
TO
Olanipekun
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic address: jason.salemi@bcm.edu.
Jason L
JL
Salemi
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Maria C
MC
Mejia de Grubb
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Sandra J
SJ
Gonzalez
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
Roger J
RJ
Zoorob
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Clostridium difficile; Infection; Nationwide Inpatient Sample; Screening; Type 2 diabetes mellitus