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The Incidence of Clostridium difficile Infection in Hospitalized Patients with Cystic Fibrosis in the United States

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Patients with cystic fibrosis (CF) are reported to have a high asymptomatic carriage rate of Clostridium difficile (C. difficile). However, most reports are limited to case reports and case series. The objective of this study was to investigate the incidence of C. difficile infection (CDI) in hospitalized patients with CF in the United States. 

Methods: Data were obtained from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2002 to 2010. Data were weighted to generate national-level estimates.

Results: For the year 2010, there were a total of 9,706,097 weighted hospital discharges in the 18 – 44 year age group. In this age cohort, 32,541 patients had a diagnosis of CDI and 19,278 patients had a diagnosis of CF. The incidence of CDI in the hospitalized CF population was 1.6% compared to an incidence of 0.3% in the non-CF hospitalized population (P<0.05). After matching to control for demographic factors and comorbidities; patients with CF continued to have a higher risk for CDI than their matched counterparts (OR 3.0 95% CI 2.6-3.5). Patients with CF + CDI had an overall worse outcome than patients with CDI only (P<0.05). Utilizing a multiple variable regression model, patients in the CF + CDI group continued to demonstrate poor outcomes compared to patients in the CDI only group. This was evident as a higher risk of death (adjusted odds ratio (aOR) 3.1 95% CI 1.9-5.1), colectomy (aOR 2.6 95% CI 1.3-5.3) and higher hospital charges (adjusted regression coefficient $42,000 95% CI $22,000- $62,000). The difference in LOS between the two groups was not significant (adjusted regression coefficient 3.3 days 95% CI 0.81-5.8 days). Between the years 2002 – 2010, the incidence of CDI in the hospitalized CF population (ages 18 – 44 years) increased from 0.9% to 1.6% whereas the incidence of CDI in the corresponding non-CF population increased from 0.2% to 0.3%. For both these groups, this represented a significant increasing trend in the incidence of CDI (P<0.05).

Conclusion: There was an increasing trend in the incidence of CDI complicating CF in the years 2002 - 2010. CDI had worse outcomes (higher risk of death, colectomy and hospital charges) in the setting of CF.

Abhishek Deshpande, MD, PhD, Infectious Diseases, Cleveland Clinic, Cleveland, OH; Medicine, Cleveland Clinic, Cleveland, OH, Chaitanya Pant, MD, Kansas University Medical Center, Kansas City, KS, Mojtaba Olyaee, MD, Gastroenterology, Kansas University Medical Center, Kansas City, KS and Thomas Sferra, MD, Pediatric Gastroenterology & Nutrition, UH Rainbow Babies & Children’s Hospital, Cleveland, OH


A. Deshpande, None

C. Pant, None

M. Olyaee, None

T. Sferra, None

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