Article Text

Download PDFPDF
Impact of coexisting pneumonia in the patients admitted with Clostridium difficile infection: a retrospective study from a national inpatient database
  1. Asim Kichloo1,2,
  2. Zain El-Amir2,
  3. Dushyant Singh Dahiya2,
  4. Jagmeet Singh3,4,
  5. Dhanshree Solanki5,
  6. Farah Wani1,
  7. Hafeez Shaka6
  1. 1Department of Medicine, Samaritan Medical Center, Watertown, New York, USA
  2. 2Department of Internal Medicine, Central Michigan University, Saginaw, Michigan, USA
  3. 3Department of Internal Medicine, Guthrie Healthcare System, Sayre, Pennsylvania, USA
  4. 4Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
  5. 5Department of Public Health, Rutgers University System, New Brunswick, New Jersey, USA
  6. 6Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  1. Correspondence to Dr Asim Kichloo, Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA; kichlooasim{at}gmail.com

Abstract

Clostridium difficile is a gram-positive anaerobic spore forming bacillus that can cause infection in a setting of antibiotic use. Pneumonia is a major cause of morbidity and mortality in an inpatient setting and is frequently associated with significant antibiotic administration. This study aims to compare the outcomes of C. difficile infection (CDI) with and without pneumonia to determine the impact of pneumonia in hospitalized patients with CDI. This population-based retrospective observational propensity matched analysis study uses data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcomes were in-hospital mortality, total hospital charges, and mean length of stay. Secondary outcomes were the rates of sepsis, septic shock, non-ST elevation myocardial infarction (NSTEMI), acute renal failure, deep vein thrombosis, and pulmonary embolism. In-hospital mortality was noted to be higher in patients with pneumonia than those without (6.5% vs 1.2%, adjusted OR (aOR) 3.85; 95% CI 2.90 to 5.11, p<0.001). The following outcomes were more prevalent in patients with pneumonia compared with those without pneumonia: sepsis (9.8% vs 1.8%, aOR 4.69, 95% CI 3.73 to 5.87, p<0.001), septic shock (4.0% vs 0.5%, aOR 6.32, 95% CI 4.43 to 9.03, p<0.001), NSTEMI (1.9% vs 0.5%, aOR 2.95, 95% CI 1.85 to 4.71, p<0.001), and acute renal failure (31.5% vs 23.1%, aOR 1.23, 95% CI 1.07 to 1.40, p=0.003). In conclusion, patients with pneumonia were associated with significantly higher rates of system-based complications and higher in-hospital mortality rates.

  • pneumonia
  • Clostridium difficile

Data availability statement

Data are available in a public, open access repository. We used and/or analyzed the NIS database, available online at http: //www.hcup-us.ahrq.gov. The NIS is a large publicly available all-payer inpatient care database in the USA, containing data on more than seven million hospital stays yearly. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

Statistics from Altmetric.com

Data availability statement

Data are available in a public, open access repository. We used and/or analyzed the NIS database, available online at http: //www.hcup-us.ahrq.gov. The NIS is a large publicly available all-payer inpatient care database in the USA, containing data on more than seven million hospital stays yearly. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations.

View Full Text

Footnotes

  • Contributors AK and ZE-A are credited with substantial contribution to the design of the work, acquisition and interpretation of the data, drafting the manuscript, statistical analysis, revision of important intellectual content, final approval of the version published, and agreement of accountability for all aspects of the work. DSD and FW are credited with substantial contribution to interpretation of data, literature review of all sections discussed, drafting of the manuscript, final approval of the version published, and agreement of accountability for all aspects of the work. JS and HS are credited with interpretation of data, literature review, specifically for the discussion section, revision of the work for critically important intellectual content, final approval of the version published, and agreement of accountability for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.