title: Trends in the Incidence and Outcomes of Hospitalized Cancer Patients WithClostridium difficileInfection: A Nationwide Analysis.
abstract: Background:Patients with cancer have several risk factors forClostridium difficileinfection (CDI), but the impact of CDI on outcomes in this population needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in patients with cancer using the National Hospital Discharge Survey (NHDS) database from 2001 to 2010.Methods:Diagnosis codes were used to identify patients with cancer and CDI events. Demographics, diagnoses, length of stay (LOS), and discharge information were abstracted. Multivariate linear and logistic regression models with weighted analysis were conducted to study CDI incidence and CDI-associated outcomes. Analyses were performed using SAS version 9.4.Results:During the 10-year study period, 20.1 million discharges had a cancer diagnosis. CDI developed in 1.09% of patients with cancer versus 0.77% of patients without cancer (adjusted odds ratio [aOR], 1.28; 95% CI, 1.28-1.29;P<.001). The incidence of CDI in patients with cancer increased during the 10-year study period (64.7 per 10,000 discharges in 2001-2002 to 109.1 in 2009-2010;P<.001). In multivariable analysis, compared with patients with cancer without CDI, patients with cancer and CDI had a longer mean LOS (5.67 days; 95% CI, 5.39-5.94) and higher rates of in-hospital mortality (aOR, 1.18; 95% CI, 1.16-1.20) and discharge to a care facility (aOR, 1.74; 95% CI, 1.72-1.75; allP<.001).Conclusions:In this national database, CDI incidence increased significantly in patients with cancer over the study period and was associated with prolonged hospitalization, increased mortality, and discharge to a care facility. Despite increased attention, CDI remained a serious infection and merits appropriate prevention and management.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
authors.forename: Arjun
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
authors.forename: Raseen
authors.initials: R
authors.lastname: Tariq
authors.affiliation: Department of Health Sciences and Research, Mayo Clinic, Jacksonville, Florida
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Frank
authors.affiliation: Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Dallas, Texas
authors.forename: Gary W
authors.initials: GW
authors.lastname: Jean
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas|Division of Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Beg
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
authors.forename: David H
authors.initials: DH
authors.lastname: Johnson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D014481:United States / Q000453:epidemiology