Abstract

INTRODUCTION: Patients with Sickle Cell Disease (SCD) are frequently hospitalized for vaso-occlusive crisis and are often given empirical antibiotic treatment which puts them at high risk for Clostridium Difficile (C. Diff) infection. There are no large studies which estimated the burden of C. Diff in SCD population. In our study, we used the nationally representative database to outline the trends and predictors of C. Diff among SCD patients. METHODS: We used National Inpatient Sample (NIS) for the years 2008-2017 by Healthcare Cost and Utilization Project. We extracted a study cohort of SCD hospitalizations using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM). C. Diff and other comorbidities were identified by ICD-9/10-CM codes and Elixhauser comorbidity software. Our primary objective was to delineate temporal trends, and predictors of C. Diff in SCD patients. We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends, predictors and outcomes. RESULTS: Out of a total 991,848 hospitalizations admitted with SCD, 5,182 (1.81%) hospitalizations were complicated with C. Diff infection. Incidence of C.Diff infection increased from 0.29% in 2008 to 0.55% in 2017 with a 6% yearly increase (OR 1.06; 95%CI 1.04-1.09 ;P < 0.001) (Figure 1). Patients who developed C.Diff infection had higher mean age (39 vs 33; P < 0.001), and more likely to be females (62% Vs. 38%,P < 0.001). Furthermore, in multivariable regression analysis, increasing age (OR 1.1; 95% CI 1.1-1.1; P < 0.0001), females (OR 1.2; 95% CI 1.1-1.4;P < 0.001), Septicemia (OR 3.6; 95% CI 3.0-4.3;P < 0.001) and Congestive Heart Failure (OR 1.3; CI 1.0-1.6; P < 0.0001) were associated with higher odds of C. Diff infection. Also comorbidities like Hypertension, Liver and Neurological Disorders were also associated with increased odds of developing C.Diff infection. Among the patients who developed C.Diff infection, 15% were discharged to long term facilities and 4% died during the hospitalization. Moreover C.Diff infection was also associated with higher Length of stay (11d Vs. 6d; P < 0.001). CONCLUSION: In this nationally representative study, we observed that incidence of C.Diff among SCD has been increasing over the last decade. We were also able to delineate several factors which were significantly associated with development of C.Diff infection which needs more in-depth studies to establish the causal relationship.Figure 1

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