Hospital Readmission and Mortality Risk Greater With Clostridioides difficile Infection

Significantly greater risks of hospital utilization, costs, and mortality were found in patients with Clostridioides difficile infection (CDI), according to findings of a new study. Results were published recently in BMC Infectious diseases.

Cited by the CDC as an urgent public health threat, CDI is a major concern for hospital, outpatient, and extended-care facilities worldwide. An estimated 453,000 cases of CDI occur per year in the United States, and risk factors include the hospital setting, being older than 65, and having previously had CDI.

“The public health impacts of CDI are signifcant, with recent studies reporting annual health care costs to be as much as $4.8 billion for acute care facilities alone and a great deal of variation in ‘extra’ length of stay (LOS) and associated costs,” said the study authors. “Recurrence rates [vary] from 5 to 50%, with an average of 20%. Such numbers are alarming, given the risk of transmission and challenges in treating recurrent infections.”

Researchers conducted a retrospective cohort study of data derived from the New York Statewide Planning and Research Cooperative (SPARCS), a large comprehensive, statewide database, to investigate the impact of CDI on LOS, rehospitalization, mortality, and costs in hospitalized patients.

The study recruited patients 18 years and older hospitalized with CDI in New York state (NYS) between January 1, 2014, and December 31, 2016, with propensity score matching performed to achieve comparability of the CDI (exposure) and non-CDI (nonexposure) groups. Of the 3,714,486 total hospital discharges in NYS, 28,874 incident CDI cases were successfully matched to 28,874 nonexposures.

The primary outcome assessed was 30-day readmission, with secondary outcomes including readmissions at 60, 90, 120, 180 days; mortality within 7, 15, 30, 180 and 360 days of discharge; hospital LOS, and total charges.

“The focus on inpatients assures greater uniformity of diagnosis and management. It is the acute care setting that integrates the epidemiologic concerns of clinical severity and patient vulnerability with the extended natural history of CDI as measured by the consequential—if crude—rehospitalization and mortality rates,” explained researchers.

Findings of the matched pairs comparison demonstrated significant risks for readmission and mortality at several time points for the exposure vs nonexposure group, as well as increases in LOS and total hospital charges:

• CDI cases were more likely to be readmitted to the hospital at 30 (28.26% vs 19.46%; P < .0001), 60 (37.65% vs 26.02%; P < .0001), 90 (42.93% vs 30.43; P < .0001) 120 (46.47% vs 33.74; P < .0001), and 180 days (51.39% vs 38.76; P < .0001).
• CDI cases exhibited greater mortality rates at 7 (3.68% vs 2.0%; P < .0001) and 180 days (20.54% vs 11.96%; P < .0001).
• CDI cases showed significantly longer LOS (P < .0001).
• CDI cases reported signifcantly greater total hospital charges (P < .0001).

“Our findings are that hospitalization with CDI is a marker with consequential health care ramifications for future research, clinical management, and health prevention,” they said.

The study authors concluded that the gut microbiome represents a crucial therapeutic target for patients with CDI and prevention strategies such as antibiotic stewardship and conservatorship of the gut microbiome warrant further investigation to assess long-term health outcomes.

References

Hirsch BE, Williams MS, Stefanov DG, et al. Health care consequences of hospitalization with Clostrioides difficile infection: a propensity score matching study. BMC Infect Dis. 2022;22(1):620. doi:10.1186/s12879-022-07594-x