Trends in the Incidence and Outcomes of Clostridium difficile Colitis in Hospitalized Patients of Febrile Neutropenia: Nationwide Analysis 2008-2014: 2017 Presidential Poster Award

Abstract

Introduction: Clostridium difficile infection (CDI) has been attracting attention lately as the most common hospital acquired infection and increasing incidence, morbidity and mortality, and increasing healthcare costs. Patients with neutropenia due to malignancy appear to be at an increased risk for developing CDI. There is currently limited data that assesses the national disease burden and outcomes of patients with febrile neutropenia who have CDI.Table: Demographics & Basic Characteristics of Febrile Neutropenia patients with and without C diff colitis.Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of febrile neutropenia with or without C. diff colitis (ICD-9 codes 288.00, 288.03,780.60 & 008.45) as primary or secondary diagnosis during the period from 2008-2014. All analyses were performed with the use of PROC SURVEYMEANS, FREQUENCY and SURVEYLOGISTIC procedures of SAS, version 9.4 (SAS Institute).Table: Univariate and Multivariate regression analysis for predictors of C. diff colitis in febrile Neutropenia & Mortality in Febrile neutropenia with C. diff colitis.Results: From 2008-2014 there were total 19422 discharges of Febrile neutropenia patients with C diff. colitis. Most of the patients were Caucasians (73.6%) with age above 50 (73.7%), majority had underlying hematological malignancy (64.7%) and 1 to 3 co-morbid conditions (95.1%). There was a rising incidence of C diff colitis in febrile neutropenia from 4.11 %(2008) to 5.83 % (2014). The In-hospital mortality showed a decreasing trend from 7.79%(2008) to 5.32%(2014), likely because of improvements in diagnostics and treatment. Similar trend was observed for median length of stay and the median hospital charges per stay. The overall mortality (6.37% vs 4.61%), Length of Stay >5 days (76.45% Vs 50.98%), Hospital charges >50000 dollars (64.43% Vs 40.29%), Colectomy and colostomy (0.35% vs 0.15%) and discharge to SNF (10.47% vs 6.43%) was significantly more in febrile neutropenia patients with C. Diff vs without C. Diff over 7 years (2008-14). Age above 65 years, Hispanic race, Hematological malignancies, urban hospital settings and sepsis were significant predictors of mortality in febrile neutropenia patients with C diff. colitis.Figure: Graph depicting trends in Mortality, incidence, Median Length of stay and Median cost of care.Conclusion: Despite the significant decrease in mortality, the incidence of C diff. colitis is rising in hospitalized febrile neutropenia patients with underlying hematological malignancies. The liberal and prolonged use of broad spectrum antibiotics in this cohort of patients is one explanation. Risk factor modification, with the best possible empiric antibiotic regimen that doesn't predispose to C. diff. is imperative for reducing mortality and healthcare costs in this cohort.