Impact of Clostridium difficile Colitis on Hospitalizations With End Stage Renal Disease (ESRD)

Abstract

Introduction: Clostridium difficile infection (CDI) is a leading cause of healthcare associated diarrhea, accounting for 12% of healthcare-associated infections. End stage renal disease (ESRD) has been associated with an increased risk of incident and recurrent CDI, as well as higher in-hospital mortality and poor treatment response among those hospitalized for CDI. However, the impact of CDI among those hospitalized with a primary or secondary diagnosis of ESRD has not been well studied in a large contemporary data base. A more complete understanding of factors related to CDI during hospitalization for ESRD could facilitate the development of more effective preventive strategies. Methods: We utilized the National Inpatient Sample (NIS) to identify all hospitalizations with a primary or secondary discharge diagnosis of ESRD (ICD-9 CM code 585.6) during the years 2005-2011. Hospitalizations complicated by CDI (ICD-9 CM code 008.45) in this cohort were then identified, and analyzed. Statistical significance of variation in the number of hospital discharges, demographics, cost of care, comorbidity measures and outcomes during the study period was determined using Cochran-Armitage trend test. Results: In 2005, there were 165,344 hospitalizations with discharge diagnoses of ESRD compared to 1,029,371 in 2011 (p-trend< 0.0001, Figure 1A). The percentage of hospitalizations with CDI increased from 2.04% in 2005 to 2.40% in 2011 (p-trend< 0.0001, figure 1B). All-cause inpatient mortality showed a numerical but nonsignificant increase (13.16% in 2005 to 14.76% in 2011) (p= 0.79, figure 1C). Cost of care increased from $31,336 in 2005 to $42,375 in 2011 (adjusted for inflation, p-trend< 0.0001, figure 1D). Analysis of the Agency for Healthcare Research and Quality (AHRQ) comorbidity measures revealed that hypertension, anemia and diabetes mellitus were some of the most commonly associated comorbidities (Figure 2).137_A Figure 1 No Caption available.137_B Figure 2 No Caption available.Conclusion: A significant increase in the number of hospitalizations for ESRD complicated by CDI was seen during the study period. Although there was no significant increase in in-hospital mortality associated with these hospitalizations, there was a significant rise in the cost of care, perhaps due to longer hospital stay, multiple interventions and increasing numbers of comorbid conditions. Further studies will be required to more fully understand how these factors influence the development and severity of CDI during hospitalization.