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

Risk of complications and mortality following recurrent and non-recurrent Clostridioides (Clostridium) difficile infection: a retrospective, observational, database study in England
Risk of complications and mortality following recurrent and non-recurrent Clostridioides (Clostridium) difficile infection: a retrospective, observational, database study in England
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 6,862 patients with HA-CDI and 13,724 without CDI. Median age was 81.0 (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, 1,140 (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.
Clostridioides difficile infection, Complications, Mortality, Recurrence
0195-6701
793-803
Enoch, David A.
194e5a02-444f-4915-9c17-0db51b5eacf7
Murray-Thomas, Tarita
506e8639-b3c2-4426-b87b-1d5b957c1e60
Adomakoh, Nicholas
ff72806d-b46f-47fb-9a44-85b01fe6ac30
Dedman, Daniel
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Georgopali, Areti
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Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Karas, Andreas
1b63cf97-7fcc-4818-8c9d-6f23c565fabf
Enoch, David A.
194e5a02-444f-4915-9c17-0db51b5eacf7
Murray-Thomas, Tarita
506e8639-b3c2-4426-b87b-1d5b957c1e60
Adomakoh, Nicholas
ff72806d-b46f-47fb-9a44-85b01fe6ac30
Dedman, Daniel
55e1b8be-bf85-466c-b220-9e96d5bfd3a8
Georgopali, Areti
6db237c1-97bc-40da-8f2b-e398395b9bde
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Karas, Andreas
1b63cf97-7fcc-4818-8c9d-6f23c565fabf

Enoch, David A., Murray-Thomas, Tarita, Adomakoh, Nicholas, Dedman, Daniel, Georgopali, Areti, Francis, Nick and Karas, Andreas (2020) Risk of complications and mortality following recurrent and non-recurrent Clostridioides (Clostridium) difficile infection: a retrospective, observational, database study in England. Journal of Hospital Infection, 106 (4), 793-803. (doi:10.1016/j.jhin.2020.09.025).

Record type: Article

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 6,862 patients with HA-CDI and 13,724 without CDI. Median age was 81.0 (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, 1,140 (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.

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Accepted/In Press date: 21 September 2020
e-pub ahead of print date: 25 September 2020
Keywords: Clostridioides difficile infection, Complications, Mortality, Recurrence

Identifiers

Local EPrints ID: 444324
URI: http://eprints.soton.ac.uk/id/eprint/444324
ISSN: 0195-6701
PURE UUID: 3bc1a229-c43e-4886-aecf-48449a9ad657
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 13 Oct 2020 16:38
Last modified: 09 Jan 2022 07:50

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Contributors

Author: David A. Enoch
Author: Tarita Murray-Thomas
Author: Nicholas Adomakoh
Author: Daniel Dedman
Author: Areti Georgopali
Author: Nick Francis ORCID iD
Author: Andreas Karas

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