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The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis
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  • Tara Lagu, MD, Baystate Health
  • Mihaela Stefan, MD, Baystate Health
  • Sarah Haessler, MD, Baystate Health
  • Thomas Higgins, MD, Baystate Health
  • Nicholas Hannon, Baystate Health
  • Jay Steingrub, MD, Baystate Health
  • Peter Lindenauer, MD, Baystate Health
Document Type
Article, Peer-reviewed
Publication Date
OBJECTIVE: To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis. BACKGROUND: Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay. MEASUREMENTS: We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups. MAIN RESULTS: Of 218,915 sepsis patients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDI patients than controls (25% vs 10%, P < 0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P < 0.001). CONCLUSIONS: After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed.
Citation Information
Lagu T, Stefan MS, Haessler S, Higgins TL, Rothberg MB, Nathanson BH, Hannon NS, Steingrub JS, Lindenauer PK. The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis. J Hosp Med. 2014 Jul;9(7):411-7.