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Clostridioides difficile Infection in COVID-19 Hospitalized Patients: A Nationwide Analysis
Xheni Deda1, Khaled Elfert2, Mustafa Gandhi1
1Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA.
Insights
Clostridioides difficile infection (CDI) significantly increases mortality in COVID-19 patients. Female gender and comorbidities are key predictors for developing CDI during COVID-19 hospitalization.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Clostridioides difficile infection (CDI) is a major healthcare-associated infection.
- The impact of CDI on outcomes for patients with coronavirus disease 2019 (COVID-19) is not well understood.
- This study investigates the association between CDI and COVID-19 outcomes.
Purpose of the Study:
- To determine if CDI exacerbates outcomes in patients hospitalized with COVID-19.
- To identify predictors of CDI in COVID-19 patients.
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database for adult COVID-19 hospitalizations in 2020.
- Comparison of baseline characteristics and outcomes between COVID-19 patients with and without CDI.
- Multivariate logistic and linear regressions to identify independent predictors of CDI and mortality.
Main Results:
- Over 1 million COVID-19 hospitalizations were analyzed, with 4,920 cases of concurrent CDI.
- Patients with both CDI and COVID-19 were older, had longer hospital stays, higher costs, and significantly higher inpatient mortality (21.6% vs. 11%).
- CDI was independently associated with increased mortality (OR 1.37), and female gender and comorbidities predicted higher CDI likelihood.
Conclusions:
- Clostridioides difficile infection is an independent risk factor for increased mortality in COVID-19 patients.
- Female sex and certain pre-existing conditions are significant predictors for developing CDI in the context of COVID-19.
Background:
Clostridioides difficile infection (CDI) is a significant healthcare-associated infection with implications for patient morbidity, mortality, and healthcare costs. However, the connection between CDI and coronavirus disease 2019 (COVID-19) infection and its influence on patient outcomes remain uncertain. This study aimed to examine the association between CDI and COVID-19, specifically investigating whether CDI worsens outcomes in patients with COVID-19. By utilizing the extensive National Inpatient Sample (NIS) database and analyzing pertinent factors, this research endeavored to enhance our understanding of CDI within the context of COVID-19.
Methods:
The NIS database was searched for adult patients hospitalized with a primary diagnosis of COVID-19 infection in 2020. Patients with a secondary diagnosis of CDI were identified and separated into two groups based on CDI status. Baseline characteristics, Charlson Comorbidity Index (CCI), and outcomes were compared between the two groups using Chi-square and t-tests. Multivariate logistic and linear regressions were performed for the identification of independent predictors of CDI and mortality.
Results:
A total of 1,045,125 COVID-19 hospitalizations were included, of which 4,920 had a secondary diagnosis of CDI. Patients with CDI and COVID-19 were older (mean age 69.9 vs. 64.2 years; P < 0.001), more likely to be female (54.1% vs. 47.1%; P < 0.001) and white (60% vs. 52.4%; P < 0.001). The CDI and COVID-19 group had a longer length of stay (14.1 vs. 7.42 days; P < 0.001), higher total hospital costs ($42,336 vs. $18,974; P < 0.001), and higher inpatient mortality (21.6% vs. 11%; P < 0.001) compared to the COVID-19 group without CDI. Patients in the CDI and COVID-19 group had a higher CCI score (51.7% with a score of 3 or more vs. 27.7%; P < 0.001), indicating a higher comorbidity burden. Multivariate logistic regression analysis revealed CDI was independently associated with increased mortality (odds ratio (OR) 1.37; P = 0.001) and showed that the female gender and several pre-existing comorbidities were associated with a higher likelihood of CDI.
Conclusion:
CDI is independently associated with increased mortality in patients admitted with COVID-19 infection. Female gender and several pre-existing comorbidities are independent predictors of CDI in COVID-19 patients.
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