Clostridium difficile infection increases acute and chronic morbidity and mortality

Abstract

Objective: The goal of this study was 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: 174,903 persons coded for CDI were compared with 1,318,538 controls. CDI was associated with increased risk of death (OR 1.77, 95% 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 stratified analysis CDI was associated with greatest risk of 30-day all-cause mortality in persons with lowest baseline probability of CDI (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 one 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 even lower-risk patients may benefit from interventions to prevent CDI.

Cost-effectiveness of Treatment Regimens for Clostridioides difficile Infection: An Evaluation of the 2018 Infectious Diseases Society of America Guidelines

“…It should be noted that the literature likely overestimates current CDI-related mortality, because many of these studies used data that are several years old (between 2005 and 2014), when metronidazole use was more common, and FMT was not yet common practice. In our model, 1-year mortality was 9.2%, consistent with prior published studies (approximately 11%) [19].…”

“…We validated our simulation model by comparing the shortterm model-predicted mortality to that observed in large CDI patient cohorts [12,[19][20][21]. Our average 60-day mortality for all 48 strategies was 8%, whereas many studies report 30-day mortality of 9%-10%.…”

Ten-Year Follow-Up of Patients Treated with Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection from a Randomized Controlled Trial and Review of the Literature

“…The high mortality rate among patients included in the trial is in concordance with other studies [ 5 , 22 , 23 ], and reflects the frailty of the relatively older patients suffering from rCDI, illustrated by older age (mean 72 years), comorbidity, and a decreased Karnofsky performance score at inclusion in the trial [ 7 ]. After termination of the trial, 85% of patients were exposed to a single or multiple course of antibiotics during follow-up.…”

Risk of complications and mortality following recurrent and non-recurrent Clostridioides difficile infection: a retrospective observational database study in England

“…Several studies have reported increased toxic megacolon, perforation and sepsis among patients with CDI [3,11e13]. Significantly higher risks of all-cause mortality have also been observed in the USA [14] and Europe [15,16]. In the UK, one study using surveillance data from Scotland estimated an almost three-fold increase in 30day mortality [17], and another reported a 50% increased risk of death up to 5e8 years after hospital admission among patients with CDI at an English teaching hospital [18].…”