The impact of hospital-onset Clostridium difficile infection on outcomes of hospitalized patients with sepsis

Tara Lagu*, Mihaela S. Stefan, Sarah Haessler, Thomas L. Higgins, Michael B. Rothberg, Brian H. Nathanson, Nicholas S. Hannon, Jay S. Steingrub, Peter K. Lindenauer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


OBJECTIVE: To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis. BACKGROUND: Most prior studies that have addressed this issue lacked adequate matching to controls, suffered from small sample size, or failed to consider time to infection. DESIGN: Retrospective cohort study. SETTING AND PATIENTS: We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutions that participated in a large multihospital database between July 1, 2004 and December 31, 2010. Among eligible patients with sepsis, we identified patients who developed HOCDI during their hospital stay. MEASUREMENTS: We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups. MAIN RESULTS: Of 218,915 sepsis patients, 2368 (1.08%) developed HOCDI. Unadjusted in-hospital mortality was significantly higher in HOCDI patients than controls (25% vs 10%, P<0.001). After multivariate adjustment, in-hospital mortality rate was 24% in cases vs. 15% in controls. In an analysis limited to survivors, adjusted length of stay (LOS) among cases with Clostridium difficile infections was 5.1 days longer than controls (95% confidence interval: 4.4-5.8) and the median-adjusted cost increase was $4916 (P<0.001). CONCLUSIONS: After rigorous adjustment for time to diagnosis and presenting severity, hospital-acquired Clostridium difficile infection was associated with increased mortality, LOS, and cost. Our results can be used to assess the cost-effectiveness of prevention programs and suggest that efforts directed toward high-risk patient populations are needed. Journal of Hospital Medicine 2014;9:411-417.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalJournal of hospital medicine
Issue number7
StatePublished - Jul 2014
Externally publishedYes

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

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