The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

被引:51
|
作者
Oake, Natalie [1 ]
Taljaard, Monica [1 ,2 ]
van Walraven, Carl [1 ,2 ,3 ,4 ]
Wilson, Kumanan [1 ,3 ]
Roth, Virginia [1 ,2 ,3 ]
Forster, Alan J. [1 ,2 ,3 ,4 ]
机构
[1] Univ Ottawa, Ottawa Hosp, Res Inst, Clin Epidemiol Program, Civ Campus,ASB 1-1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada
[2] Univ Ottawa, Fac Med, Dept Epidemiol & Community Med, Ottawa, ON K1Y 4E9, Canada
[3] Univ Ottawa, Fac Med, Dept Med, Ottawa, ON K1Y 4E9, Canada
[4] Inst Clin Evaluat Sci, Ottawa, ON, Canada
关键词
FRACTIONAL POLYNOMIALS; DISEASE; DIARRHEA; MORBIDITY; COLITIS;
D O I
10.1001/archinternmed.2010.405
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission. Methods: This retrospective observational study used data from the Ottawa Hospital (Ottawa, Ontario, Canada) data warehouse. Inpatient admissions with a start date after July 1, 2002, and a discharge date before March 31, 2009, were included. Stratified analyses and a Cox multivariate proportional hazards regression model were used to determine if hospital-acquired CDI was associated with time to in-hospital death. Results: A total of 136 877 admissions were included. Hospital-acquired CDI was identified in 1393 admissions (overall risk per admission, 1.02%; 95% confidence interval [CI], 0.97%-1.06%). The risk of hospital-acquired CDI significantly increased as the baseline mortality risk increased: from 0.2% to 2.6% in the lowest to highest deciles of baseline risk. Hospital-acquired CDI significantly increased the absolute risk of in-hospital death across all deciles of baseline risk (pooled absolute increase, 11%; 95% CI, 9%-13%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI (95% CI, 2.4-3.7); this hazard ratio decreased with increasing baseline mortality risk. Conclusions: Hospital-acquired CDI was independently associated with an increased risk of in-hospital death. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.
引用
收藏
页码:1804 / 1810
页数:7
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