Publication
Title
Clostridioides difficile infection-associated cause-specific and all-cause mortality : a population-based cohort study
Author
Abstract
Objectives: Clostridioides difficile infection (CDI) is a common healthcare-associated infection and leading cause of gastroenteritis-related mortality worldwide. However, data on CDI-associated mortality are scarce. We aimed to examine the association between CDI and all-cause and cause-specific mortality. We additionally explored contributing causes of mortality, including recurrent CDI, hospital-or community acquired CDI, chronic comorbidities, and age. Methods: This nationwide population-based cohort study (from 2006 to 2019) compared individuals with CDI with the entire Swedish background population using standardized mortality ratios. In addition, a matched-cohort design (1:10), utilizing multivariable Poisson-regression models, provided incidence rate ratios (IRRs) with 95% CIs. Results: This study included 43 150 individuals with CDI and 355 172 controls. In total, 69.7% were >65 years, and 54.9% were female. CDI was associated with a 3-to 7-fold increased mortality rate (IRR = 3.5, 95% CI: 3.3-3.6; standardized mortality ratio = 6.8, 95% CI: 6.7-6.9) compared with the matched controls and Swedish background population, respectively. Mortality rates were highest for hospital-acquired CDI (IRR = 2.4, 95% CI: 1.9-3.2) and during the first CDI episode (IRR = 0.2, 95% CI: 0.2-0.3 for recurrent versus first CDI). Individuals with CDI had more chronic comorbidities than controls, yet mortality remained higher among CDI cases even after adjustment and stratification for comorbidity; CDI was associated with increased mortality (IRR = 6.1, 95% CI: 5.5-6.8), particularly among those without any chronic comorbidities. Discussion: CDI was associated with elevated all-cause and cause-specific mortality, despite possible confounding by ill health. Mortality rates were consistently increased across sexes, all age groups, and comorbidity groups. Annelies Boven, Clin Microbiol Infect 2023;29:1424 (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
Language
English
Source (journal)
Clinical microbiology and infection / European Society of Clinical Microbiology and Infectious Diseases. - Oxford
Publication
Oxford : 2023
ISSN
1198-743X [print]
1469-0691 [online]
DOI
10.1016/J.CMI.2023.07.008
Volume/pages
29 :11 (2023) , p. 1424-1430
ISI
001105693700001
Pubmed ID
37473840
Full text (Publisher's DOI)
Full text (open access)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identifier
Creation 09.01.2024
Last edited 04.03.2024
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