Clostridioides Difficile Infection Associated With Increased Risk of All-Cause Mortality

Clostridioides difficile infection (CDI) was associated with an increased risk of all-cause and cause-specific mortality, with the morality risk being highest during a first episode of CDI, according to the results of a study published in Clinical Microbiology and Infection.Particularly, the mortality rates were still consistent across both sexes, all age groups, and comorbidity groups, according to the results of the study.¹

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In a review published in BMC Infectious Diseases, the incidence of CDI appeared to be highest in the United States and Poland, as of 2021 data. The authors of the review stated that there is a substantial burden with CDI and an unmet need for new and novel treatments for antibiotic resistance, as well as new and emerging strains of CDI.²

According to the study authors, CDI is the leading cause of gastroenteritis-related mortality worldwide, but there are little data on CDI-associated mortality.¹ Investigators of the current study sought to examine the association between CDI and all-cause and cause-specific mortality. They also sought to determine contributing causes of mortality, which included recurrent CDI, hospital- or community-acquired CDI, chronic comorbidities, and age.¹

Investigators included all individuals from Sweden with CDI episodes recorded between January 1, 2006, and December 31, 2019, with a maximum follow up of 14 months.¹

Patients were all individually matched to up to 10 controls. Exposure was defined as 1 or more CDI episodes any time within the study period, which were divided by community- and hospital-acquired CDI. Recurrence was defined as a CDI episode within 8 weeks after initial CDI diagnosis.¹

There were 43,150 individuals with CDI included in the study, of whom 16.8% had recurrent CDI and 91.6% had hospital-acquired CDI. There were also 355,172 individuals included as controls.¹

There was a median follow up time of 2 years for those with CDI and 5.5 years for the control group. Approximately 74.8% were aged 65 years or older, 21.3% were aged 20 to 64 years, and 3.9% were aged under 20 years.¹

The results of the study found that CDI was associated with higher comorbidity scores at a mean of 3.2 compared to 1.6 for the control group. For recurrent CDI, individuals had higher comorbidity scores than those without recurrence, with the largest differences for scores 0 at 13.1% and 14.4%, respectively.¹

Investigators reported that 61.6% of individuals with CDI died during the study period compared to the control group at 28.8%. The majority of deaths occurred among those who were aged 65 years and older. For recurrent CDI, approximately 24.9% of individuals aged less than 65 years died compared with 68.7% of those aged 65 years or older.¹

It was also found that the most common causes of deaths were cardiovascular disease and cancer.¹ CDI was associated with a 7-fold increase in all-cause mortality rate when compared to the Swedish background population and a 4-fold increase when compared to the individually matched controls. Investigators found that all-cause mortality rates decreased with age.¹

Furthermore, investigators found that individuals with CDI had the highest mortality rates among individuals without comorbidities and those with the highest comorbidity scores.¹ The findings also showed that most individuals with CDI died within 30 days from cardiovascular- or cancer-related causes, but the mortality risk increased after 1 year of diagnosis.¹

The authors of the study noted that a possible limitation would be that Sweden does not require CDI-reporting, so many cases of CDI could have remained undiagnosed or unreported.¹

References

1. Boven A, Vlieghe E, Engstrand L, Andersson FL, et al. Clostridioides difficile infection-associated cause-specific and all-cause mortality: a population-based cohort study. Clin Microbiol Infect. 2023;S1198-743X(23)00315-4. doi:10.1016/j.cmi.2023.07.008
2. Finn E, Andersson FL, Madin-Warburton M. Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI. BMC Infect Dis. 2021;21(1):456. doi:10.1186/s12879-021-06147-y