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Clostridioides difficile infection in hematologic malignancy patients with and without bone marrow transplantation: A
Nency Ganatra1, Jacob Thompson2, Iqra Qazi1
1Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, United States.
Insights
Clostridioides difficile infection (CDI) significantly worsens outcomes for hematologic malignancy (HM) patients, increasing mortality and hospital costs. The risk is highest for patients undergoing bone marrow transplant (BMT) with concurrent CDI.
Area of Science:
- Hematology
- Infectious Diseases
- Health Services Research
Background:
- Clostridioides difficile infection (CDI) is a major complication in patients with hematologic malignancies (HMs).
- Data comparing CDI impact in HMs with and without bone marrow transplant (BMT) is limited.
- Understanding CDI's effect on inpatient outcomes is crucial for this vulnerable population.
Purpose of the Study:
- To evaluate the association between CDI and inpatient outcomes (mortality, LOS, hospital charges) in HM hospitalizations.
- To compare these outcomes between HM patients with and without BMT.
- To identify the combined impact of CDI and BMT on HM hospitalizations.
Main Methods:
- Retrospective cross-sectional analysis using the Nationwide Inpatient Sample.
- Multivariable logistic and Poisson regression models were used.
- Adjusted analyses accounted for demographic and clinical covariates.
Main Results:
- CDI was independently associated with increased in-hospital mortality, length of stay (LOS), and hospital charges.
- Bone marrow transplant (BMT) also significantly increased mortality, LOS, and charges.
- Concurrent CDI and BMT demonstrated the highest burden, with significantly elevated mortality risk and resource utilization.
Conclusions:
- CDI is linked to worse clinical and economic outcomes in hospitalized HM patients.
- The highest risk is observed in post-BMT settings.
- Targeted CDI prevention, diagnosis, and treatment are vital for reducing morbidity, mortality, and resource use in HM patients.
Abstract:
Clostridioides difficile infection (CDI) is a frequent and consequential healthcare-associated complication in patients with hematologic malignancies (HMs), particularly in the setting of bone marrow transplant (BMT); however, national data comparing the impact of CDI across HM hospitalizations with and without BMT remain significantly limited. To evaluate associations between CDI and key inpatient outcomes like in-hospital mortality, length of stay (LOS), and total hospital charges, this retrospective cross-sectional analysis was conducted using the Nationwide Inpatient Sample. Multivariable models were fitted using survey-weighted logistic regression for mortality and Poisson regression with a log link for LOS and charges, adjusting for demographic and clinical covariates to calculate adjusted odds ratios and incidence rate ratios. Among an estimated 2.86 million adult HM hospitalizations, most involved neither exposure, while smaller proportions involved BMT only, CDI only, or both. In adjusted analyses, CDI was independently associated with higher odds of in-hospital death and substantially increased LOS and hospital charges. BMT was associated with markedly higher mortality and pronounced increases in LOS and charges. Hospitalizations complicated by concurrent CDI and BMT demonstrated the greatest burden across outcomes, with significantly increased mortality risk and the largest increases in LOS and charges (all p < 0.001). These findings indicate that CDI was associated with worse clinical and economic outcomes in hospitalized HM patients, with the highest risk observed when CDI occurs in post-transplant settings. Targeted prevention, early diagnosis, and prompt treatment of CDI therefore represent high-yield opportunities to reduce inpatient morbidity, mortality, and resource utilization in this vulnerable population.
