Predictors of mortality and length of stay in patients with hospital-acquired Clostridioides difficile infection: a population-based study in Alberta, Canada

J Leal; P Ronksley; E A Henderson; J Conly; B Manns

doi:10.1016/j.jhin.2019.04.007

Predictors of mortality and length of stay in patients with hospital-acquired Clostridioides difficile infection: a population-based study in Alberta, Canada

J Hosp Infect. 2019 Sep;103(1):85-91. doi: 10.1016/j.jhin.2019.04.007. Epub 2019 Apr 13.

Authors

J Leal¹, P Ronksley², E A Henderson¹, J Conly³, B Manns⁴

Affiliations

¹ Department of Community Health Sciences, University of Calgary, Calgary, Canada; Infection Prevention and Control, Alberta Health Services, Calgary, Canada.
² Department of Community Health Sciences, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Canada.
³ Department of Medicine, University of Calgary, Calgary, Canada; Departments of Microbiology, Immunology, and Infectious Diseases, Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Canada; Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Canada.
⁴ Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada. Electronic address: braden.manns@albertahealthservices.ca.

PMID: 30991081
DOI: 10.1016/j.jhin.2019.04.007

Abstract

In a population-based, five-year retrospective cohort study of 5304 adult patients with hospital-acquired Clostridioides difficile infection across Alberta (N=101 hospitals), 30-day all-cause and attributable mortality were 12.2% and 4.5%, respectively. Patients >75 years of age had the highest odds of attributable mortality (odds ratio (OR) 9.34, 95% confidence interval (CI) 2.92-29.83) and largest difference in mean length of stay (11.7 days, 95% CI 8.2-15.2). A novel finding was that elevated white blood cell count at admission was associated with reduced attributable mortality (OR 0.67, 95% CI 0.50-0.90) which deserves further study. Advancing age was incrementally and significantly associated with all outcomes.

Keywords: Attributable mortality; Clostridioides difficile; Epidemiology; Length of stay.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alberta / epidemiology
Clinical Decision Rules*
Clostridium Infections / diagnosis*
Clostridium Infections / epidemiology
Clostridium Infections / mortality*
Clostridium Infections / pathology
Cross Infection / diagnosis*
Cross Infection / epidemiology
Cross Infection / mortality*
Cross Infection / pathology
Female
Humans
Length of Stay*
Leukocyte Count*
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Analysis
Young Adult