Clostridioides difficile infection-associated cause-specific and all-cause mortality : a population-based cohort study
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
|---|---|
| Enthalten in: |
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - (2023) vom: 19. Juli |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Boven, Annelies [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
C. difficile infection |
|---|
| Anmerkungen: |
Date Revised 03.08.2023 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1016/j.cmi.2023.07.008 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM359742769 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM359742769 | ||
| 003 | DE-627 | ||
| 005 | 20231226081527.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.cmi.2023.07.008 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1199.xml |
| 035 | |a (DE-627)NLM359742769 | ||
| 035 | |a (NLM)37473840 | ||
| 035 | |a (PII)S1198-743X(23)00315-4 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Boven, Annelies |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clostridioides difficile infection-associated cause-specific and all-cause mortality |b a population-based cohort study |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 03.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a C. difficile infection | |
| 650 | 4 | |a CDI | |
| 650 | 4 | |a Cohort | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Real-world evidence | |
| 650 | 4 | |a Recurrent CDI | |
| 650 | 4 | |a rCDI | |
| 700 | 1 | |a Vlieghe, Erika |e verfasserin |4 aut | |
| 700 | 1 | |a Engstrand, Lars |e verfasserin |4 aut | |
| 700 | 1 | |a Andersson, Fredrik L |e verfasserin |4 aut | |
| 700 | 1 | |a Callens, Steven |e verfasserin |4 aut | |
| 700 | 1 | |a Simin, Johanna |e verfasserin |4 aut | |
| 700 | 1 | |a Brusselaers, Nele |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases |d 1995 |g (2023) vom: 19. Juli |w (DE-627)NLM094580014 |x 1469-0691 |7 nnns |
| 773 | 1 | 8 | |g year:2023 |g day:19 |g month:07 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.cmi.2023.07.008 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2023 |b 19 |c 07 | ||