Boven A, Vlieghe E, Engstrand L, Andersson FL, Callens S, Simin J, Brusselaers N. Clostridioides difficile infection-associated cause-specific and all-cause mortality: A population-based cohort study.
Clin Microbiol Infect 2023:S1198-743X(23)00315-4. [PMID:
37473840 DOI:
10.1016/j.cmi.2023.07.008]
[Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES
Clostridioides difficile infection (CDI) is a common healthcare-associated infection and leading cause of gastroenteritis-related mortality worldwide. However, data on CDI-associated mortality are scarce. We aimed to examine the association between CDI and all-cause and cause-specific mortality. We additionally explored contributing causes of mortality, including recurrent CDI (rCDI), hospital- or community-acquired CDI, chronic comorbidities, and age.
METHODS
This nationwide population-based cohort study (from 2006-2019) compared individuals with CDI to the entire Swedish background population using standardized mortality ratios (SMRs). Additionally, a matched cohort design (1:10), utilizing multivariable Poisson regression models, provided incidence rate ratios (IRRs) with 95% confidence intervals (CIs).
RESULTS
This study included 43,150 individuals with CDI and 355,172 controls. In total, 69.7% were ≥65 years, and 54.9% were female. CDI was associated with a 3- to 7-fold increased mortality rate (IRR=3.5, 95% CI: 3.3-3.6; SMR=6.8, 95% CI:6.7-6.9) compared to the matched controls and Swedish background population, respectively. Mortality rates were highest for hospital-acquired CDI (IRR=2.4, 95% CI: 1.9-3.2) and during the first CDI episode (IRR=0. 2, 95% CI: 0.2-0.3 for recurrent versus first CDI). Individuals with CDI had more chronic comorbidities than controls, yet mortality remained higher among CDI cases even after adjustment and stratification for comorbidity; CDI was associated with increased mortality (IRR=6.1, 95% CI: 5.5-6.8), particularly among those without any chronic comorbidities.
CONCLUSIONS
CDI was associated with elevated all-cause and cause-specific mortality, despite possible confounding by ill health. Mortality rates were consistently increased across both sexes, all age groups, and comorbidity groups.
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