Methods: We performed a retrospective cohort study of patients with CDI using MHS database billing records. Cases included all active duty patients, their dependents, or retirees admitted to a US military treatment facility for ≥2 days from October 2008 to September 2015 with a stool sample positive for Clostridium difficile via enzyme immunoassay, tissue cytotoxin assay, toxigenic culture, or polymerase chain reaction (PCR). Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjusted logistic regression.
Results: Among 1,156,672 admissions within the MHS from 2008-2015, we identified 1,640 (0.14%) patients with CDI and found a significant increase in the trend of CDI over the 7-year study period (P<0.001). Median age (IQR) was 63 (41-76) in the CDI hospitalized group and 26 (6-46) in the non-CDI hospitalized group. Male gender was a risk factor for CDI (unadjusted odds ratio, 1.94; 95% confidence interval 1.76-2.14) and the majority of patients (84.5%) were associated with large-size medical centers. Patients hospitalized with CDI had significantly higher hospitalization cost (attributable difference [AD] $51,959, P<0.001), prolonged hospital stay (AD 11.8 days, P<0.001), and in-hospital mortality (case-mix adjusted odds ratio 3.28; 95% confidence interval 2.69-4.00).
Conclusion: CDI in hospitalized patients within the MHS is associated with advanced age, large medical centers, and an increased length of stay, hospital cost, and in-hospital mortality. We identified a significantly increased burden of hospitalization among patients admitted with CDI, highlighting the importance of infection control and antimicrobial stewardship initiatives aimed at decreasing the spread of this pathogen.
M. Rajnik, None
D. Adams, None
C. Nylund, None
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