National Trends (2007-2013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome

BACKGROUND: Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea and is associated with worse outcomes and higher cost. Patients with septic shock (SS) are at increased risk of acquiring C. difficile infections (CDIs) during hospitalization, but little data are available on CDI complicating SS.

OBJECTIVE: Prevalence of CDI in SS between 2007-2013 and impact of CDI on outcomes in SS.

DESIGN: We used the National Inpatient Sample to identify hospitalizations (2007-2013) of adults with SS and CDI and the Nationwide Readmissions Database 2013 to calculate 30-day readmissions.

MAIN MEASUREMENTS: Outcomes were prevalence of CDI in SS, effect on mortality, length of stay (LOS), and 30-day readmission.

RESULTS: There were 2,031,739 hospitalizations with SS (2007-2013). CDI was present in 8.2% of SS. The in-hospital mortality of SS with and without CDI were comparable (37.1% vs 37.0%; P = 0.48). Median LOS was longer for SS with CDI (13 days vs 9 days; P < 0.001). LOS >75th percentile (>17 days) was 36.9% in SS with CDI vs 22.7% without CDI (P < 0.001). Similarly, LOS > 90th percentile (> 29 days) was 17.5% vs 9.1%, P < 0.001. Odds of LOS >75% and >90% in SS were greater with CDI (odds ratio [OR] 2.11; 95% confidence interval [CI], 2.06-2.15; P < 0.001 and OR 2.25; 95% CI, 2.22-2.28; P < 0.001, respectively). Hospital readmission of SS with CDI was increased, adjusted OR 1.26 (95% CI, 1.22-1.31; P < 0.001).

CONCLUSIONS: CDI complicating SS is common and is associated with increased hospital LOS and 30-day hospital readmission. This represents a population in which a focus on prevention and treatment may improve clinical outcomes.