The Clinical Burden of Clostridioides difficile in Ontario, Canada. (14th December 2019)

• Record Type: Journal Article
• Authors: Pereira, Jennifer A; McGeer, Allison; Tomovici, Antigona; Selmani, Alex; Chit, Ayman
• Is Part Of: Open forum infectious diseases. Volume 7:Number 2(2020)
• Publication Date: 2019-12-14
• Subjects: Clostridioides difficile -- cohort -- infectious disease; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofz523
• Languages: English
• ISSNs: 2328-8957

Abstract

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. Abstract : Compared with controls, Clostridioides difficile infection (CDI) is associated with higher rates of rehospitalization within 30 days as well as higher mortality within 180 days of hospital discharge when associated with the community or long-term care facilities.