Introduction: Clostridium difficile infection (CDI) is an important cause of hospital acquired morbidity and mortality. This is the first nationwide analysis of the predictors for developing CDI and its impact on the outcomes after aneurysmal subarachnoid hemorrhage (SAH).
Methods: Data were extracted from the National Inpatient Sample (2002–2010). Patients with subarachnoid hemorrhage who underwent microsurgical or endovascular aneurysm repair were included. Multivariate logistic regression with forward prediction modeling was employed to determine the predictors of developing CDI. Potential predictors evaluated included patient age, admission year, comorbidities, expected primary payer, ventriculostomy, mechanical ventilation, post-procedural infectious and non-infectious complications, and hospital demographics (teaching status, bed size, and region). Thereafter, additional models were constructed to assess the impact of CDI on mortality, length of stay, and discharge disposition.
Results: 16,531 admissions were examined, of which 1.91% (n=316) developed CDI. Independent predictors of developing CDI were Medicaid payer status; ventriculostomy; prolonged mechanical ventilation; a greater number of non-infectious complications; as well as the development of a urinary tract infection; pneumonia; meningitis/ventriculitis; and sepsis (all P=0.03). Admission at a hospital in the South was associated with a decreased risk of CDI (P=0.008). CDI was not found to be associated with significantly different odds of in-hospital mortality (OR 0.67; 95% CI 0.39, 1.16, P=0.17). However, CDI was associated with increased adjusted odds of a hospital stay of at least 24 days (OR 3.27; 95% CI 2.41, 4.45, P<0.001) and of a non-routine hospital discharge (OR 1.49; 95% CI 1.05, 2.16, P=0.03).
Conclusions: In this nationwide analysis, both infectious and non-infectious complications as well as hospital geography were found to be predictors of developing CDI. Although CDI was not associated with mortality, those with CDI had some inferior outcomes, including longer hospital stay and greater odds of a non-routine hospital discharge.
Patient Care: By identifying risk factors for CDI following a SAH and subsequent independent effects on outcomes, we are able to 1) identify which patients should be closely monitored for CDI 2) open a conversation about why discrepancies exist across regions and insurance plans.
Learning Objectives: By the conclusion of this presentation, participants should be able to:
1) Identify risk factors for C. difficile infection (CDI) following subarachnoid hemorrhage (SAH)
2) Understand impact of CDI on periprocedural outcomes following SAH
3) Understand that both infectious and non-infectious complications were found to associated with CDI suggesting patient susceptibility is also based on overall health