CDI linked to adverse outcomes among hospitalized patients with cancer

For hospitalized cancer patients, contracting Clostridioides difficile infection (CDI) contributes to a substantial increase in mortality and healthcare resource use, according to a cross-sectional study.

Researchers used data from the National Inpatient Sample and identified hospitalizations among adults with a diagnosis of cancer. They determined the presence of CDI as a primary or secondary diagnosis during the index hospitalization.

In-hospital, all-cause mortality was the primary outcome. Secondary outcomes included need for kidney replacement therapy, mechanical ventilation, vasopressor support, and colonoscopy.

The analysis included 32,083,671 cancer-related hospitalizations, of which 450 360 (1.4 percent) involved a diagnosis of CDI. The mean patient age was 69.4 years, and 50 percent were male.

Compared with hospitalizations without CDI, those with CDI involved older patients, a higher percentage of women, and higher prevalence of haematologic cancers, cirrhosis, solid organ transplant, bone marrow transplant, chronic kidney disease, and inflammatory bowel disease.

CDI was associated with higher in-hospital mortality (7.3 percent vs 4.5 percent; adjusted odds ratio [aOR], 1.62, 95 percent confidence interval [CI], 1.58–1.67). CDI was also associated with higher rates of critical care interventions, such as kidney replacement therapy (44.3 vs 20.4 per 1,000 hospitalizations; aOR, 2.00, 95 percent CI, 1.92–2.08; p<0.001), mechanical ventilation (68.1 vs 35.6 per 1,000 hospitalizations; aOR, 1.89, 95 percent CI, 1.84–1.95; p<0.001), and vasopressor use (25.6 vs 11.5 per 1,000 hospitalizations; aOR, 2.11; 95 percent CI, 2.00–2.24; p<0.001).

The risk increase for mortality among hospitalized patients with CDI varied geographically, ranging from 6.4 percent in the Midwest to 8.5 percent in the Northeast.

These findings highlight the need for targeted prevention and early intervention strategies in this vulnerable population, the researchers said.