Abstract 17921: Clostridium difficile Infection is Associated with Worse Outcomes in Heart Failure Hospitalizations: National Hospital Discharge Survey

Abstract

Introduction: Clostridium difficile infection (CDI) is a leading cause of nosocomial diarrhea with increasing incidence, severity and mortality. We report the first study examining the risk and outcomes of CDI in a large national cohort of hospitalized congestive heart failure (CHF) patients.

Methods: Data for 2005-2009 were obtained from the National Hospital Discharge Survey (NHDS), which includes nationally representative information on patient demographics, diagnoses, procedures and dismissals in the US. Weighted analyses were performed to evaluate the association between CDI and length of hospital stay (LoS), discharge to short or long-term care facility (DtCF) and all cause in-hospital mortality among patients with CHF.

Results: There were an estimated 162 million adult hospitalizations for 2005-2009 of which 18.3 million (11.3%) had CHF (median age 76 years, 45.3% male). The CDI rate in was higher in CHF (1.19%) compared to non-CHF hospitalizations (0.73%), OR 1.64 (95% CI 1.63-1.65). On univariate analysis, among patients with CHF, CDI was associated with a longer LoS, median 8 (IQR 5-14) vs. 5 (3-8) days; higher DtCF, OR 2.73 (2.70-2.75); and increased mortality, OR 1.51 (1.49-1.54); all p<0.0001. On multivariate adjustment for age, sex, and comorbidities including hypertension, diabetes mellitus, pulmonary disorders, neurological disorders, renal failure, AIDS and malignancies, CDI remained associated with longer LoS by 4.0 (95% CI 3.7-4.3) days; higher DtCF, OR 2.34 (2.32-2.37); and increased mortality, OR 1.22 (1.20-1.24); all p<0.0001.

Conclusions: These data suggest that patients with CHF have a higher risk of CDI. Despite advancements in infection control and CDI management, CHF patients with CDI have increased hospital-associated morbidity and mortality. Further investigation is needed to identify effective CDI prevention and management strategies specifically in hospitalized CHF patients.