Higher Mortality Rates Associated with Clostridioides difficile
Infection in Hospitalized Children with Cystic Fibrosis
Abstract
Objective(s): To determine the impact of
Clostridioides difficile Infection (CDI) among pediatric
Cystic Fibrosis (CF) hospitalizations using a large nationally
representative pediatric hospital database . Study
design: We identified Cystic Fibrosis-related hospitalizations during
the years 1997 to 2016 in the Kids’ Inpatient Database [KID] and
compared in-hospital mortality, Length of Stay [LOS], and hospital
charges among hospitalizations with and without a coexisting diagnosis
of C. difficile using logistic regression models for mortality
and general linear models with gamma distribution and logarithmic
transformation for LOS and hospital charges. We also evaluated temporal
trends in the proportion of CF hospitalizations with concomitant CDI
using data published triennially Results: We analyzed 21, 616
pediatric CF hospitalizations between the years 1997 to 2016 and found a
total of 240 (1.1%) hospitalizations with concurrent CDI diagnosis.
Adjusted analyses demonstrated an association of CDI with increased
mortality (OR 5.2, 95% 95% CI 2.5-10.7), longer LOS (46.5% increment,
95% CI 36.0-57.1), and higher charges (65.8% increment, 95% CI
53.5-78.1) for all comparisons. The proportion of CF hospitalizations
with CDI increased over time from 0.64% in 1997 to 1.73% in 2016
(p<0.001). Conclusion(s): As CDI is associated with
excess mortality, LOS, and cost in children hospitalized for CF, efforts
to reduce infection rates and aggressive diagnosis and treatment of
active infections should be prioritized to improve hospital outcomes
among children with CF.