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Duhan S, Taha A, Keisham B, Badu I, Atti L, Hussein MH, Sandhyavenu H, Uppal D, Tantry US, Bliden KP, Tarff A, Ali S, Ali S, Rout A, Gurbel PA. Outcomes of Clostridioides difficile infection in acute heart failure hospitalizations: insights from the National Inpatient Database. J Hosp Infect 2024; 145:129-139. [PMID: 38145812 DOI: 10.1016/j.jhin.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients. AIM To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020. METHODS Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed. FINDINGS Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI. CONCLUSION The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.
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Affiliation(s)
- S Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - A Taha
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - B Keisham
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA
| | - I Badu
- Department of Internal Medicine, Onslow Memorial Hospital, Jacksonville, NC, USA
| | - L Atti
- Department of Internal Medicine, Michigan State University, MI, USA
| | - M H Hussein
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA
| | - H Sandhyavenu
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - D Uppal
- Department of Cardiology, Cleveland Clinic, Weston, FL, USA
| | - U S Tantry
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA
| | - K P Bliden
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA
| | - A Tarff
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - S Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | - S Ali
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - A Rout
- Division of Cardiology, University of Louisville, Louisville, KY, USA.
| | - P A Gurbel
- Sinai Center for Thrombosis Research, Sinai Hospital, Baltimore, MD, USA
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