P2240 - Clostridiodes difficile Infection Incidence Proportion and Outcomes in Cancer-Related Admissions: A Nationwide Study (2015-2017)

Leticia E. Campoverde, MD¹, Giovanni Roldán, MD², Han Wool Kim, BS^3
1University of Miami, Jackson Memorial Hospital, Miami, FL; ²University of Miami- Jackson Memorial Hospital, Miami, FL; ³University of Miami Miller School of Medicine, Miami, FL

Introduction: Clostridiodes difficile infection (CDI) is the most common nosocomial infection and one of the leading causes of inpatient morbidity and mortality worldwide. According to the CDC, in 2017, there were 223,900 estimated cases of CDI in hospitalized patients [1]. Patients with cancer are particularly vulnerable to CDI and may have as twice as high the rate of hospital-acquired CDI compared to all other inpatients [2]. This association might be explained by frequent hospitalization, antibiotic use, an immunosuppressed state, and the disruption of the gut microbiome. This study aims to provide nationally representative estimates of the incidence proportion and outcomes of CDI in cancer-related hospitalizations [3].

Methods: We performed a cross-sectional analysis of the National Inpatient Sample (NIS) dataset for 2015-2017. We queried inpatient hospitalizations using ICD-10 codes for all cancer-related admissions and CDI as a diagnosis during the hospital course. The primary outcome was the incidence proportion of CDI in patients with any malignancy. Secondary outcomes included differences in mortality and healthcare utilization, including length of stay, number of procedures, and total hospital charges. Categorical variables were assessed by Chi-squared test and continuous variable by t-test. Statistical analysis was performed using R Studio software.

Results: A total of 1,242,625 patients had an oncologic-related admission between 2015 and 2017 in the US. Twenty-three thousand five hundred seventy-two patients (1.90%) were diagnosed with CDI during their hospital stay. When compared to oncologic patients without CDI during the admission, patients with CDI were younger (63.8 years old vs. 64.2, p< 0.01), mainly female (50.7 % vs. 47.2%, p< 0.01), white (69.9% vs. 68.5%, p< 0.01), had a higher comorbidity index (4.92 vs. 4.26, p< 0.01) and had a non-elective admission (84% vs. 71.4, p< 0.01). The mean length of stay was 12.0 days vs. 6.1 days in patients without CDI (p< 0.01). The total charges were $128,000 in the CDI group vs. $70,300 in the non-CDI group (p< 0.01). Oncologic patients with CDI have higher mortality than patients without CDI, 8.8% vs. 5.5% (p< 0.01).

Discussion: Oncologic patients with CDI have different demographic characteristics than oncologic patients without CDI. The median length of stay, total charges, and mortality are significantly higher in oncologic patients with CDI.

Variable	No CDI (n= 1219053 )	CDI (n= 23572 )	p-value
Female (%)	575323 (47.2)	11961 (50.7)	< 0.01
Mean age, years (SD)	64.2 (17.2)	63.8 (19.1)	< 0.01
Race (%)
White	835379 (68.5)	16475 (69.9)	< 0.01
Black	152583 (12.5)	2608 (11.1)	0.02
Hispanic	103113 (8.5)	1977 (8.4)	0.71
Asian or pacific islander	36575 (3.0)	670 (2.8)	0.16
Native American	4889 (0.4)	109 (0.5)	0.15
Other	38179 (3.1)	738 (3.1)	1
Elixhauser comorbidity index, score (SD)	4.26 (2.20)	4.92 (2.24)	< 0.01
Elective hospitalization (%)
No	871574 (71.5)	19820 (84.1)	< 0.01
Yes	343917 (28.2)	3672 (15.6)	< 0.01
Median household income percentile (%) *
0-25th	322727 (26.5)	5854 (24.8)	< 0.01
26th to 50th	301181 (24.7)	5800 (24.6)	0.73
51st to 75th	295278 (24.2)	5867 (24.9)	0.02
76th to 100th	278493 (22.8)	5657 (24.0)	< 0.01
Location/teaching status of hospital (%)
Rural	79687 (6.5)	1356 (5.8)	< 0.01
Urban nonteaching	237163 (19.5)	4562 (19.4)	0.70
Urban teaching	902203 (74.0)	17654 (74.9)	< 0.01
Inpatient outcomes
Mean length of stay, days (SD)	6.08 (7.29)	12.00 (13.9)	< 0.01
Mean Total Charges, USD (SD)	70300 (108000)	128000 (231000)	< 0.01
Mean number of procedures (SD)	2.19 (2.66)	2.57 (3.44)	< 0.01
Inpatient hospitalization (%)	66577 (5.5)	2020 (8.6)	< 0.01

*Median household income for patient's ZIP Code (based on current year).

Table: Table 1. Demographic characteristics and inpatient outcomes in oncologic patients with and without CDI in 2015-2017 in the US.


Disclosures:
Leticia Campoverde indicated no relevant financial relationships.
Giovanni Roldán indicated no relevant financial relationships.
Han Wool Kim indicated no relevant financial relationships.


Leticia E. Campoverde, MD¹, Giovanni Roldán, MD², Han Wool Kim, BS³. P2240 - Clostridiodes difficile Infection Incidence Proportion and Outcomes in Cancer-Related Admissions: A Nationwide Study (2015-2017), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.