• Tara Lagu, Mihaela S Stefan, Sarah Haessler, Thomas L Higgins, Michael B Rothberg, Brian H Nathanson, Nicholas S Hannon, Jay S Steingrub, and Peter K Lindenauer.
• Department of Medicine, Center for Quality of Care Research, Baystate Medical Center, Springfield, Masachusetts; Division of General Medicine, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
• J Hosp Med. 2014 Jul 1; 9 (7): 411-7.

ObjectiveTo examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis.BackgroundMost prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection.DesignRetrospective cohort study.Setting And PatientsWe 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.MeasurementsWe used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups.Main ResultsOf 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).ConclusionsAfter 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.© 2014 Society of Hospital Medicine.

26 keywords...

hide…