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

D. A. Enoch*, T. Murray-Thomas, N. Adomakoh, D. Dedman, A. Georgopali, N. A. Francis, A. Karas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Clostridioides difficile infection (CDI) increases the risk of complications and mortality. We assessed the magnitude of these outcomes in a large cohort of English patients with initial and recurrent CDI. Aim: To compare the risk of complications and all-cause mortality, within 12 months, among hospitalized patients ≥18 years old with hospital-associated- (HA-) CDI and recurrent CDI. Methods: Patients with HA-CDI during 2002–2013 were identified using inpatient hospital data linked to primary care and death data. Each HA-CDI case was frequency matched to two hospitalized patients without CDI on age group, sex, calendar year of admission, admission method and number of hospital care episodes. A second CDI episode starting on days 13–56 was defined as recurrence. Risks of mortality and complications at 12 months were analysed using Cox proportional hazard models. Findings: We included 6862 patients with HA-CDI and 13,724 without CDI. Median age was 81.0 years (IQR 71.0–87.0). Patients with HA-CDI had more comorbidities than those without CDI, and significantly higher risks of mortality (adjusted hazard ratio (95% confidence interval) 1.77 (1.67–1.87)) and complications (1.66 (1.46–1.88)) within 12 months from hospital admission. Of those with HA-CDI, 1140 (16.6%) experienced CDI recurrence. Patients with recurrent versus non-recurrent CDI also had significantly increased risk of mortality (1.32 (1.20–1.45)) and complications (1.37 (1.01–1.84)) in the 12 months from the initial CDI. Conclusions: HA-CDI (versus no CDI) and recurrent CDI are both associated with significantly higher risks of complications or death within 12 months of the initial CDI episode.

Original languageEnglish
Pages (from-to)793-803
Number of pages11
JournalJournal of Hospital Infection
Volume106
Issue number4
DOIs
Publication statusPublished - Dec 2020

Bibliographical note

Funding Information:
This study was funded by Astellas Pharma Europe Ltd. We wish to thank Reiner Tretter, statistician at Astellas Pharma Inc. at the time of this study, for his contribution to the analysis and Iona Easthope, DPhil, of Cello Health MedErgy for medical writing services. Previous presentations: oral presentation at the 25th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), 25th?28th April 2015, Copenhagen, Denmark; e-poster at the 27th ECCMID, 22nd?25th April 2017, Vienna, Austria.

Funding Information:
This study was funded by Astellas Pharma Europe Ltd. We wish to thank Reiner Tretter, statistician at Astellas Pharma Inc. at the time of this study, for his contribution to the analysis and Iona Easthope, DPhil, of Cello Health MedErgy for medical writing services. Previous presentations: oral presentation at the 25th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), 25 th −28 th April 2015, Copenhagen, Denmark; e-poster at the 27th ECCMID, 22 nd –25 th April 2017, Vienna, Austria.

Publisher Copyright:
© 2020 The Authors

Keywords

  • Clostridioides difficile infection
  • Complications
  • Mortality
  • Recurrence

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