Predictors of in-hospital mortality among patients with clostridium difficile infection: a multicenter study

Abstract Background Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (oVAN) is known to be superior to treatment with metronidazole. However, previous studies have not evaluated the impact on patients when oVAN therapy is delayed after diagnosis or suspicion of severe CDI. Methods This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI as defined by a white blood cell (WBC) count greater than 15,000 cells/mm3. The primary outcome was in-hospital mortality between patients treated initially with oVAN vs. delayed oVAN after metronidazole. Secondary outcomes included clinical cure by day 10, post-infection length of hospitalization, the time to resolution of leukocytosis and renal function at the end of treatment. Leukocytosis was defined as a WBC greater than 12,000 cells/mm3. Patients were excluded if they received oVAN for a previous episode of CDI, were receiving treatment for a concurrent infection, were receiving high-dose steroids, or received metronidazole or oVAN within 5 days preceding CDI diagnosis. Results A total of 121 patients were included. Overall, 49% of patients were female and the median age was 67 years old. 101 patients comprised the initial oVAN group, while 20 patients comprised the delayed oVAN group. Baseline demographics did not differ significantly between groups other than the time to initiation of oVAN (0.33 vs. 3.18 days, P < 0.001). There was no significant difference in in-hospital mortality for patients in the initial oVAN treatment group compared with those who had delayed oVAN therapy (5% vs. 15%, P = 0.13). Patients who received oVAN initially experienced a higher rate of clinical cure by day 10 (49.5% vs. 20%, P = 0.02), a shorter median post-infection length of hospitalization (7 days vs. 13 days, P < 0.001), a shorter median time to resolution of leukocytosis (3.9 days vs. 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs. 29.4%, P = 0.03). Conclusion Patients who receive oVAN as their initial treatment for severe CDI have improved clinical outcomes compared with those initially treated with metronidazole. Disclosures All authors: No reported disclosures.

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Association of Clostridium difficile infection in hospital mortality: A systematic review and meta-analysis

American Journal of Infection Control ◽

10.1016/j.ajic.2015.04.209 ◽

2015 ◽

Vol 43 (12) ◽

pp. 1316-1320 ◽

Cited By ~ 17

Author(s):

Tianyi Gao ◽

Bangshun He ◽

Yuqin Pan ◽

Qiwen Deng ◽

Huiling Sun ◽

...

Keyword(s):

Systematic Review ◽

Clostridium Difficile ◽

Hospital Mortality ◽

Clostridium Difficile Infection ◽

Meta Analysis

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The In-hospital Mortality Rate for Clostridium difficile Infection has Decreased Over the Past Decade in the United States: A 10-Year Nationwide Analysis

The American Journal of Gastroenterology ◽

10.14309/00000434-201710001-01107 ◽

2017 ◽

Vol 112 ◽

pp. S604-S605

Author(s):

Paul T. Kroner ◽

Juan E. Corral ◽

Marwan Abougergi ◽

Christopher C. Thompson

Keyword(s):

United States ◽

Mortality Rate ◽

Clostridium Difficile ◽

Hospital Mortality ◽

Clostridium Difficile Infection ◽

The United States ◽

The Past

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Incidence and outcomes of hospitalized patients with gastrointestinal malignancies and Clostridium difficile infection: A nationwide analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.704 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 704-704

Author(s):

Arjun Gupta ◽

Raseen Tariq ◽

Nivedita Arora ◽

Ryan D. Frank ◽

Muhammad S. Beg ◽

...

Keyword(s):

Clostridium Difficile ◽

Hospital Mortality ◽

Cancer Patients ◽

Clostridium Difficile Infection ◽

Care Facility ◽

Hospitalized Patients ◽

National Database ◽

Gastrointestinal Malignancies ◽

Gi Cancer ◽

The Impact

704 Background: Inpatients with gastrointestinal (GI) malignancies are at a high risk for Clostridium difficile infection (CDI) but the impact of CDI on outcomes in these patients needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in GI cancer patients using the National Hospital Discharge Survey (NHDS) database from 2001 - 2010. Methods: NHDS collects clinical information on patients dismissed from non-Federal short-stay United States hospitals. Demographics, diagnoses (GI malignancies, CDI and comorbidities), length of stay (LOS), and dismissal information were abstracted using ICD-9 diagnosis and procedure codes. Weighted analyses were performed using SAS version 9.4. Results: Of an estimated 317.9 million unique hospitalizations; 4.6 million had a diagnosis of a GI malignancy (1.4%); median age 68 years, 46.1% female. CDI was more common in patients with GI malignancies compared to patients with no GI malignancy (1.05% vs 0.69%, aOR 1.16, 95% CI 1.15- 1.17, p < 0.0001). There was a significant increase in CDI incidence in GI cancer patients over the 10-year study period (72.7 in 2001-2002 to 109.1 in 2009-2010, per 10,000 discharges, p < 0001). In multivariable analysis, compared to GI cancer patients without CDI, GI cancer patients with CDI had a longer mean LOS (3.94 more days, 95% CI 3.31-4.56) and dismissal to a care facility (adjusted OR, 1.75; 95% CI, 1.71-1.79), but lower all-cause in-hospital mortality (adjusted OR, 0.76; 95% CI, 0.74-0.79), all p < 0.0001 Conclusions: In this national database of hospitalized patients, an increasing incidence of CDI in patients with GI malignancies was noted over the study period. CDI prolonged hospitalization, and was associated with increased dismissal to a care-facility. Lower rates of in-hospital mortality may represent early diagnosis due to vigilance or a milder form of CDI. Despite increased attention over the last few decades, CDI remained a serious infection in GI cancer patients, and merits appropriate prevention, management and follow-up.

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