Clostridium difficile infection is associated with poor outcomes in end-stage renal disease

J Investig Med. 2012 Feb;60(2):529-32. doi: 10.2310/JIM.0b013e318242b313.

Abstract

Objective: To investigate the association of Clostridium difficile infection (CDI) with the outcomes of hospitalized patients with end-stage renal disease (ESRD).

Methods: We extracted all adult cases with a discharge diagnosis of ESRD or CDI from the United States Nationwide Inpatient Sample 2009 database. Outcome variables (mortality, length of hospital stay [LOS], and hospitalization charges), demographic information, and comorbidity data were collected. Data were evaluated by univariate and multiple regression analyses.

Results: We identified 184,139 cases with ESRD of which 2.8% had CDI. Comparison of patients with ESRD + CDI to those with only ESRD revealed in-hospital mortality (13.2% vs 5.3%; P < 0.001), LOS (17.3 vs 7.1 days; P < 0.001), and charges ($124,846 vs $56,663; P < 0.001) to be more than 2-fold greater. In the ESRD cohort (ESRD only and ESRD + CDI), CDI was independently associated with greater mortality (adjusted odds ratio, 2.15; 95% CI, 2.07-2.24; P < 0.001), longer LOS (mean difference, 9.4 days; 95% CI, 9.2-9.5; P < 0.001), and higher charges (mean difference, $62,824; 95% CI, 61,615-64,033; P < 0.001).

Conclusions: Clostridium difficile infection is associated with significantly worse outcomes in hospitalized patients with ESRD.

MeSH terms

  • Aged
  • Clostridium Infections / complications*
  • Clostridium Infections / microbiology*
  • Clostridium Infections / mortality
  • Clostridium difficile / physiology*
  • Cohort Studies
  • Demography
  • Female
  • Humans
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / microbiology*
  • Kidney Failure, Chronic / mortality
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Treatment Outcome
  • United States / epidemiology