C. difficile infection associated with high recurrence, mortality rates
Individuals with a Clostridium difficile (C. difficile) infection have a high risk of all-cause mortality and recurrence is common in those who survive, according to a study presented at ECCMID 2017*.
Researchers led by Professor Alistair Leanord from the University of Glasgow, Scotland, UK, identified 3,304 patients with C. difficile infection (58 percent female, 22 percent aged ≥85 years) in hospitals in Scotland between 2010 and 2013 and compared them with 9,516 individuals without the infection (control group). About two-thirds of the cases were nosocomial. [ECCMID 2017, abstract OS0224]
Patients with a C. difficile infection had a higher risk of death from any cause within 2 months of hospitalization compared with those without the infection (29 percent vs 14 percent, hazard ratio [HR], 2.2, 95 percent confidence interval [CI], 1.9–2.5).
Twenty-two percent of those with a C. difficile infection died before discharge compared with 9 percent of those without an infection.
Of the 1,712 patients with C. difficile infection who were discharged within 30 days of initial infection, 59 percent were hospitalized again within 6 months, while of the 626 patients who were discharged more than 30 days after initial infection, 53 percent were hospitalized again within 6 months.
However, few of the readmissions were directly linked to C. difficile infection, said the researchers.
Duration of hospitalization was a median 9.7 days longer among those with C. difficile infection than those without.
Of the 2,740 individuals who survived the initial infection, infection recurred in 14 percent within 90 days. Three hundred and seventy one patients with a recurrence survived; of these, 29 percent had a second recurrence within one year of the first recurrence, mostly occurring within 90 days of the first recurrence.
Age was associated with the risk of recurrence (HR, 1.9, 95 percent CI, 1.9–3.3 in patients aged ≥85 years compared with <65 years), while existing comorbidities did not appear to be linked to risk of recurrence.
“Having a clear understanding of the nature of C. difficile infections in Scotland will allow the Scottish government to target resources at the most appropriate patients to try to reduce the overall burden of the disease on the health service,” said Leanord. “Our findings are very likely to be applicable to the rest of the UK and other countries as well.”