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
相关论文
共 50 条
  • [1] The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital
    Forster, Alan J.
    Taljaard, Monica
    Oake, Natalie
    Wilson, Kumanan
    Roth, Virginia
    van Walraven, Carl
    [J]. CANADIAN MEDICAL ASSOCIATION JOURNAL, 2012, 184 (01) : 37 - 42
  • [2] Postoperative Burden of Hospital-Acquired Clostridium difficile Infection
    Abdelsattar, Zaid M.
    Krapohl, Greta
    Alrahmani, Layan
    Banerjee, Mousumi
    Krell, Robert W.
    Wong, Sandra L.
    Campbell, Darrell A., Jr.
    Aronoff, David M.
    Hendren, Samantha
    [J]. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2015, 36 (01): : 40 - 46
  • [3] CLOSTRIDIUM DIFFICILE - THE EPIDEMIOLOGY AND PREVENTION OF HOSPITAL-ACQUIRED INFECTION
    BURDON, DW
    [J]. INFECTION, 1982, 10 (04) : 203 - 204
  • [4] Financial burden of hospital-acquired Clostridium difficile infection
    Wilcox, MH
    Cunniffe, JG
    Trundle, C
    Redpath, C
    [J]. JOURNAL OF HOSPITAL INFECTION, 1996, 34 (01) : 23 - 30
  • [5] Impact of hospital-acquired Clostridium difficile
    Lipp, Michael J.
    Nero, Damion C.
    Callahan, Mark A.
    [J]. JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2012, 27 (11) : 1733 - 1737
  • [6] Hospital-acquired Clostridium difficile infection: determinants for severe disease
    Wenisch, J. M.
    Schmidt, D.
    Kuo, H. W.
    Simons, E.
    Allerberger, F.
    Michl, V.
    Tesik, P.
    Tucek, G.
    Wenisch, C.
    [J]. WIENER KLINISCHE WOCHENSCHRIFT, 2012, 124 (15-16) : 591 - 591
  • [7] Hospital-acquired Clostridium difficile infection: determinants for severe disease
    Wenisch, J. M.
    Schmid, D.
    Kuo, H. -W.
    Simons, E.
    Allerberger, F.
    Michl, V.
    Tesik, P.
    Tucek, G.
    Wenisch, C.
    [J]. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2012, 31 (08) : 1923 - 1930
  • [8] Hospital-acquired Clostridium difficile infection: determinants for severe disease
    J. M. Wenisch
    D. Schmid
    H.-W. Kuo
    E. Simons
    F. Allerberger
    V. Michl
    P. Tesik
    G. Tucek
    C. Wenisch
    [J]. European Journal of Clinical Microbiology & Infectious Diseases, 2012, 31 : 1923 - 1930
  • [9] Hospital-acquired Clostridium difficile infection: an institutional costing analysis
    Choi, K. B.
    Suh, K. N.
    Muldoon, K. A.
    Roth, V. R.
    Forster, A. J.
    [J]. JOURNAL OF HOSPITAL INFECTION, 2019, 102 (02) : 141 - 147
  • [10] The Association of Inpatient Occupancy with Hospital-Acquired Clostridium difficile Infection
    Abir, Mahshid
    Goldstick, Jason
    Malsberger, Rosalie
    Setodji, Claude M.
    Dev, Sharmistha
    Wenger, Neil
    [J]. JOURNAL OF HOSPITAL MEDICINE, 2018, 13 (10) : 698 - 701