In the Journals Plus

C. difficile infection mortality rates higher in initial episode in veterans

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August 10, 2018

Haley J. Appaneal, PharmD
Haley J. Appaneal

Initial episodes of Clostridium difficile infection had a higher rate of crude mortality compared with a third recurrence in a national cohort of veterans, according to study results published in Open Forum Infectious Diseases.

“We developed a national cohort of over 50,000 veterans with Clostridium difficile infection (CDI) to describe crude mortality rates and identify independent predictors of mortality in patients with recurrent CDI,” Haley J. Appaneal, PharmD, research health scientist at Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, told Infectious Disease News. “In our large national cohort, crude mortality decreased by 44% from the initial episode to the third recurrence.” 

Appaneal and colleagues studied Veterans Affairs patients with a first CDI, which was defined as positive C. difficile toxins stool sample and at least 2 days of CDI treatments, who were treated at a VA facility between May 1, 2010, and Dec. 30, 2014. Additional CDI episodes at least 14 days after the stool test date and within 30 days of treatment completion were defined as subsequent recurrences.

The researchers defined mortality as death from any cause within 30 days from the end of CDI treatment of the prior episode. In an analysis, they compared patients who died with control patients who survived at 30 days from the end of treatment of recurrence and who were matched by year, facility and severity. Four hundred-forty control patients were matched to 110 deaths.  

Initial CDI episode had a crude all-cause mortality rate of 10.6%. For recurrences of CDI, rates were 8.3% for first recurrence, 4.2% for second recurrence and 5.9% for third recurrence.

The researchers identified six predictors of mortality, including proton pump inhibitor (PPI) use (OR = 3,86; 95% CI, 2.14-6.96), antibiotic use (OR = 3.33; 95% CI, 1.79-6.17), respiratory failure (OR = 8.26; 95% CI, 1.71-39.92), cognitive dysfunction (OR = 2.41; 95% CI, 1.02-5.72), nutrition deficiency (OR = 2.91; 95% CI, 1.37-6.21) and age (OR = 1.04; 95% CI, 1.01-1.07).

“Our findings may assist health care providers in identifying patients at high risk of mortality after a first recurrence of CDI,” Appaneal said. by Bruce Thiel

Disclosure: Appaneal reports being supported in part by a Career Development Award, Department of Veterans Affairs, and having received research funding from Merck (Cubist). Please see the study for the other authors’ relevant financial disclosures.