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

ABSTRACT: To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis.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.Retrospective cohort study.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.We used propensity matching and date of diagnosis to match cases to patients without Clostridium difficile infections and compared outcomes between the 2 groups.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?

SUBMITTER: Lagu T

PROVIDER: S-EPMC4079761 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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

Lagu Tara T Stefan Mihaela S MS Haessler Sarah S Higgins Thomas L TL Rothberg Michael B MB Nathanson Brian H BH Hannon Nicholas S NS Steingrub Jay S JS Lindenauer Peter K PK

Journal of hospital medicine 20140409 7

<h4>Objective</h4>To examine the impact of hospital-onset Clostridium difficile infection (HOCDI) on the outcomes of patients with sepsis.<h4>Background</h4>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.<h4>Design</h4>Retrospective cohort study.<h4>Setting and patients</h4>We identified adults with a principal or secondary diagnosis of sepsis who received care at 1 of the institutio ...[more]

PMID: 24715578

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Project description:BackgroundDevastating cases of sepsis in previously healthy patients have received widespread attention and have helped to catalyze state and national mandates to improve sepsis detection and care. However, it is unclear what proportion of patients hospitalized with sepsis previously were healthy and how their outcomes compare with those of patients with comorbidities.Research questionAmong adults hospitalized with community-onset sepsis, how many previously were healthy and how do their outcomes compare with those of patients with comorbidities?Study design and methodsWe retrospectively identified all adults with community-onset sepsis hospitalized in 373 US hospitals from 2009 through 2015 using clinical indicators of presumed infection and organ dysfunction (Centers for Disease Control and Prevention's Adult Sepsis Event criteria). Comorbidities were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We applied generalized linear mixed models to measure the associations between the presence or absence of comorbidities and short-term mortality (in-hospital death or discharge to hospice), adjusting for severity of illness on admission.ResultsOf 6,715,286 hospitalized patients, 337,983 (5.0%) were hospitalized with community-onset sepsis. Most patients with sepsis (329,052 [97.4%]) had received a diagnosis of at least one comorbidity; only 2.6% previously were healthy. Patients with sepsis who previously were healthy were younger than those with comorbidities (mean age, 58.0 ± 19.8 years vs 67.0 ± 16.5 years), were less likely to require ICU care on admission (37.9% vs 50.5%), and were more likely to be discharged home (57.9% vs 45.6%), rather than to subacute facilities (16.3% vs 30.8%), but showed higher short-term mortality rates (22.8% vs 20.8%; P < .001 for all). The association between previously healthy status and higher short-term mortality persisted after risk adjustment (adjusted OR, 1.99; 95% CI, 1.87-2.13).InterpretationThe vast majority of patients hospitalized with community-onset sepsis harbor pre-existing comorbidities. However, previously healthy patients may be more likely to die when they seek treatment at the hospital with sepsis compared with patients with comorbidities. These findings underscore the importance of early sepsis recognition and treatment for all patients.

Dataset Information

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

Publications

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

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