J Hosp Infect. 2023 Dec 23:S0195-6701(23)00412-7. doi: 10.1016/j.jhin.2023.11.022. Online ahead of print.
ABSTRACT
Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of co-morbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients. Limited information is available regarding the impact and outcomes of concurrent CDIs in patients admitted with acute HF exacerbation. The National Inpatient Sample (NIS) database from 2016 to 2020 was queried to identify patients with a diagnosis of Acute HF and stratified based on the presence of CDI. Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed. Of 536,595 acute HF hospitalizations in this time frame, 3,030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio (aOR) 1.91, 95% confidence interval (CI) 1.48-2.45), cardiac arrest (aOR 1.66, 95% CI 1.01-2.70), and use of mechanical circulatory support (MCS) (aOR 2.42, 95% CI 1.71-3.42). In propensity-matched analysis, in-hospital mortality (13.71 vs. 8.44%, p=0.005), septic shock (7.54 vs. 3.33%, p=0.002), and use of MCS (7.19 vs. 3.68%, p=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74, 95% CI 3.24-4.31) and liver disease (aOR 2.97, 95% CI 2.55-3.46) showed the strongest association as independent predictors of mortality. Additionally, HF patients with CDI had longer hospital stays (14.45±19.40 vs. 5.44±7.10 days, p<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs. $60,740 ± 153,992, p<0.001) compared to those without CDI. Thus, the occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and expenditure of more healthcare dollars.
PMID:38145812 | DOI:10.1016/j.jhin.2023.11.022