Patients with Liver Transplants (LT) are at high risk for nosocomial infections such as Clostridium difficile (C. diff) colitis. There are limited reports on the epidemiological trends, morbidity and mortality associated with C. Diff infection in the LT patient populations. By examining a large national database in the United States, we identified the epidemiological trends, risk factors and clinical outcomes of C. Diff colitis among the LT recipients in the past decade.
We extracted data from LT patients using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM) from the National Inpatient Sample (NIS) between 2007 and 2017. C diff and associated clinical information were identified by ICD-9/10-CM codes and validated using Elixhauser comorbidity software. We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends, predictors and outcomes using SAS 9.4 version.
Among the LT patients in the NIS, there were 12,248 (3.29%) cases of C. diff colitis from 372,814 hospitalizations. The incidence of C.diff increased from 25/1000 in 2008 to 32/1000 in 2017 with a 3% annual increase rate (OR 1.03; 95% CI 1.01-1.05; P = 0.001). Patients who developed C.diff were more likely to be males (55%), caucasians (73%), and age 35-50 years (48%). In a multivariable regression analysis, male gender (OR 1.2; 95% CI 1.2–1.3; P < 0.001), septicemia (OR 2.0; 95% CI 1.8–2.2; P < 0.001), renal Failure (OR 1.2; 95% CI 1.1–1.4; P < 0.001), thyroid (OR 1.2; 95% CI 1.1–1.3; P < 0.001) and neurological disorders (OR 1.2; CI 1.01–1.3; P:0.03) were associated with higher risks of C. diff colitis. Although C. diff colitis did not result in an increase in-hospital mortality, it was associated with greater length of stay in the hospital (10d Vs. 6d; P < 0.001) and higher cost burden. C.diff colitis also led to an increase likelihood of discharging to subacute care facility (OR 1.5; 95% CI 1.3–1.7; P < 0.001); this trend increased from 17% in 2008 to 26% in 2017 (P < 0.01).
In this nationally representative study, we observed the incidence of C.diff colitis among LT recipients has been increasing over the last decade. C.diff colitis is associated with longer hospital stay and considerable morbidity. Early diagnosis and treatment of these susceptible populations is critically important. Further studies are needed to implement preventive strategies to reduce nosocomial C.diff infection.