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Outcomes of Clostridium difficile Infection in Hospitalized Leukemia Patients: A Nationwide Analysis

Published online by Cambridge University Press:  24 March 2015

Ruihong Luo ,
Alan Greenberg  and
Christian D. Stone
Ruihong Luo
Affiliation:
Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada
Alan Greenberg
Affiliation:
Infectious Disease Specialists, University Medical Center, Las Vegas, Nevada
Christian D. Stone*
Affiliation:
Section of Gastroenterology and Hepatology, University of Nevada School of Medicine, Las Vegas, Nevada
*
Address all correspondence to Christian D. Stone, MD, MPH, Associate Professor of Medicine, Section of Gastroenterology and Hepatology, University of Nevada School of Medicine, 2040 W. Charleston Blvd, Suite 300, Las Vegas, NV 89102 ([email protected]).
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Abstract

BACKGROUND

The incidence of Clostridium difficile infection (CDI) has increased among hospitalized patients and is a common complication of leukemia. We investigated the risks for and outcomes of CDI in hospitalized leukemia patients.

METHODS

Adults with a primary diagnosis of leukemia were extracted from the United States Nationwide Inpatient Sample database, 2005–2011. The primary outcomes of interest were CDI incidence, CDI-associated mortality, length of stay (LOS), and charges. In a secondary analysis, we sought to identify independent risk factors for CDI in leukemia patients. Logistic regression was used to derive odds ratios (ORs) adjusted for potential confounders.

RESULTS

A total of 1,243,107 leukemia hospitalizations were identified. Overall CDI incidence was 3.4% and increased from 3.0% to 3.5% during the 7-year study period. Leukemia patients had 2.6-fold higher risk for CDI than non-leukemia patients, adjusted for LOS. CDI was associated with a 20% increase in mortality of leukemia patients, as well as 2.6 times prolonged LOS and higher hospital charges. Multivariate analysis revealed that age >65 years (OR, 1.13), male gender (OR, 1.14), prolonged LOS, admission to teaching hospital (OR, 1.16), complications of sepsis (OR, 1.83), neutropenia (OR, 1.35), renal failure (OR, 1.18), and bone marrow or stem cell transplantation (OR, 1.27) were significantly associated with CDI occurrence.

CONCLUSIONS

Hospitalized leukemia patients have greater than twice the risk of CDI than non-leukemia patients. The incidence of CDI in this population increased 16.7% from 2005 to 2011. Development of CDI in leukemia patients was associated with increased mortality, longer LOS, and higher hospital charges.

Infect Control Hosp Epidemiol 2015;36(7):794–801

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 7 , July 2015 , pp. 794 - 801
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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