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Clostridium difficile infection increases acute and chronic morbidity and mortality

Published online by Cambridge University Press:  09 November 2018

Margaret A. Olsen ,
Dustin Stwalley ,
Clarisse Demont  and
Erik R. Dubberke
Margaret A. Olsen*
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri Department of Surgery, Washington University School of Medicine, St Louis, Missouri
Dustin Stwalley
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Clarisse Demont
Affiliation:
Sanofi Pasteur, Lyon, France
Erik R. Dubberke*
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Authors for correspondence: Margaret A. Olsen, PhD, MPH, Division of Infectious Diseases, Campus Box 8051, Washington University School of Medicine, 4523 Clayton Ave, St Louis, MO 63110. E-mail: molsen@wustl.edu or Erik R. Dubberke, MD, MSPH, Division of Infectious Diseases, Campus Box 8051, Washington University School of Medicine, 4523 Clayton Ave, St Louis, MO 63110. E-mail: edubberk@wustl.edu
Authors for correspondence: Margaret A. Olsen, PhD, MPH, Division of Infectious Diseases, Campus Box 8051, Washington University School of Medicine, 4523 Clayton Ave, St Louis, MO 63110. E-mail: molsen@wustl.edu or Erik R. Dubberke, MD, MSPH, Division of Infectious Diseases, Campus Box 8051, Washington University School of Medicine, 4523 Clayton Ave, St Louis, MO 63110. E-mail: edubberk@wustl.edu
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Abstract

Objective

In this study, we aimed to quantify short- and long-term outcomes of Clostridium difficile infection (CDI) in the elderly, including all-cause mortality, transfer to a facility, and hospitalizations.

Design

Retrospective study using 2011 Medicare claims data, including all elderly persons coded for CDI and a sample of uninfected persons. Analysis of propensity score-matched pairs and the entire population stratified by the propensity score was used to determine the risk of all-cause mortality, new transfer to a long-term care facility (LTCF), and short-term skilled nursing facility (SNF), and subsequent hospitalizations within 30, 90, and 365 days.

Results

The claims records of 174,903 patients coded for CDI were compared with those of 1,318,538 control patients. CDI was associated with increased risk of death (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.74–1.81; attributable mortality, 10.9%), new LTCF transfer (OR, 1.74; 95% CI, 1.67–1.82), and new SNF transfer (OR, 2.52; 95% CI, 2.46–2.58) within 30 days in matched-pairs analyses. In a stratified analysis, CDI was associated with greatest risk of 30-day all-cause mortality in persons with lowest baseline probability of CDI (hazard ratio [HR], 3.04; 95% CI, 2.83–3.26); the risk progressively decreased as the baseline probability of CDI increased. CDI was also associated with increased risk of subsequent 30-day, 90-day, and 1-year hospitalization.

Conclusions

CDI was associated with increased risk of short- and long-term adverse outcomes, including transfer to short- and long-term care facilities, hospitalization, and all-cause mortality. The magnitude of mortality risk varied depending on baseline probability of CDI, suggesting that even lower-risk patients may benefit from interventions to prevent CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 65 - 71
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: The preliminary findings of this study were presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) conference on April 10, 2016 in Amsterdam, Netherlands.

Cite this article: Olsen MA, et al. (2019). Clostridium difficile infection increases acute and chronic morbidity and mortality. Infection Control & Hospital Epidemiology 2019, 40, 65–71. doi: 10.1017/ice.2018.280

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