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. 2019 Jan;40(1):65-71.
doi: 10.1017/ice.2018.280. Epub 2018 Nov 9.

Clostridium difficile infection increases acute and chronic morbidity and mortality

Margaret A Olsen  1 , Dustin Stwalley  1 , Clarisse Demont  2 , Erik R Dubberke  1
Affiliations

Clostridium difficile infection increases acute and chronic morbidity and mortality

Margaret A Olsen et al. Infect Control Hosp Epidemiol. 2019 Jan.

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.

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Conflict of interest statement

D.S. reports no conflicts of interest relevant to this manuscript.

Figures

Figure 1
Figure 1
Stratified Hazard Ratios and Rates of Outcomes within One year after CDI or Control Index Date. Outcomes are: A. Mortality, B. New Entry into a Long-Term Care Facility. The bars represent the respective event rates controls (open bars) and CDI cases (grey bars). formula image Hazard ratio and 95% confidence interval.
Figure 2
Figure 2
Stratified Hazard Ratios and Rates of Hospitalization within 30 days after CDI or Control Index Date. The number of total patient included in the hospitalization analyses was 1,475,045 (158,558 CDI case patients and 1,316,487 control patients), after excluding 18,396 persons who died during the index hospitalization. The bars represent the hospitalization rates in control patients (open bars) and CDI case patients (grey bars). formula image Hazard ratio and 95% confidence interval. The null hazard ratio of 1.0 is indicated by the horizontal dashed line.
See this image and copyright information in PMC

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