The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis

J Hosp Med. 2014 Jul;9(7):411-7. doi: 10.1002/jhm.2199. Epub 2014 Apr 9.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clostridioides difficile*
  • Clostridium Infections / diagnosis
  • Clostridium Infections / mortality*
  • Clostridium Infections / therapy
  • Cohort Studies
  • Cross Infection / diagnosis
  • Cross Infection / mortality*
  • Cross Infection / therapy
  • Female
  • Hospital Mortality / trends*
  • Hospitalization / trends*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sepsis / diagnosis
  • Sepsis / mortality*
  • Sepsis / therapy
  • Treatment Outcome