The Clinical Burden of Clostridioides difficile in Ontario, Canada

Jennifer A Pereira; Allison McGeer; Antigona Tomovici; Alex Selmani; Ayman Chit

doi:10.1093/ofid/ofz523

The Clinical Burden of Clostridioides difficile in Ontario, Canada

Open Forum Infect Dis. 2019 Dec 14;7(2):ofz523. doi: 10.1093/ofid/ofz523. eCollection 2020 Feb.

Authors

Jennifer A Pereira¹, Allison McGeer², Antigona Tomovici³, Alex Selmani⁴, Ayman Chit⁴

Affiliations

¹ JRL Research and Consulting Inc., Toronto, Canada.
² Department of Microbiology, Mount Sinai Hospital, Toronto, Canada.
³ Sanofi Pasteur, Toronto, Canada.
⁴ Sanofi Pasteur, Swiftwater, Pennsylvania, USA.

Abstract

Background: To understand the clinical burden of Clostridioides difficile infection (CDI), we analyzed health outcome data from Ontario, Canada for CDI associated with and manifested in acute care hospitals (ACH), long-term care facilities (LTCF), the community, or ACH-associated with community-onset.

Methods: We performed a retrospective analysis using individual-level data from Ontario databases (April 1, 2005 to March 31, 2015), identifying CDI cases ≥18 years requiring hospitalization, and stratifying into cohorts based on association and onset location. Cohort members were matched to controls on demographics and medical conditions at onset, for outcomes including 30- and 180-day all-cause mortality and rehospitalization.

Results: We stratified 22 617 individuals hospitalized with CDI during the study period: 13 152 (58.1%) ACH-associated/ACH-onset, 7116 (31.5%) community-associated/community-onset, 1847 (8.2%) ACH-associated/community-onset, and 502 (2.2%) LTCF-associated/LTCF-onset. Compared with controls, unadjusted 30-day rehospitalization rates were significantly higher (P < .0001) for ACH-associated/ACH-onset CDI (9.5% vs 0.4%), LTCF-associated/LTCF-onset (7.2% vs 1.1%), community-associated/community-onset (7.8% vs 0.8%), and ACH-associated/community-onset (10.9% vs 0.7%). One hundred eighty-day mortality rates were higher in the community-associated/community-onset and the LTCF-associated/LTCF-onset cohorts than controls: 66.3% vs 12.3% (P < .0001) and 30.9% vs 3.1% (P < .0001), respectively. All differences remained significant after adjusting for patient factors.

Conclusions: Clostridioides difficile infection is associated with higher rates of 30-day rehospitalization compared with controls. In addition, mortality rates within 180-days of hospital discharge are significantly higher for community-associated/community-onset and LTCF-associated/LTCF-onset CDI cohorts than controls. Clostridioides difficile infection warrants increased prevention and monitoring efforts.

Keywords: Clostridioides difficile; cohort; infectious disease.