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Clostridium difficile–Related 30-Day Mortality: A Case-Control Study

Schousboe, Mona FRCPA*; Barrett, Ruth MN; Wildbore, Anne-Marie RN

Infectious Diseases in Clinical Practice: November 2013 - Volume 21 - Issue 6 - p 366–372
doi: 10.1097/IPC.0b013e318279f033
Original Articles

Background Clostridium difficile infection (CDI) is related to the use of antibiotics and ranges in severity from mild diarrhea to pseudomembranous colitis and death. A new strain of C. difficile (polymerase chain reaction ribotype 027) has been associated with increased severity of CDI and outbreaks but is still uncommon in New Zealand or Australia. The mortality related to CDI in the Canterbury District Health Board region is unknown.

Methods This was a case-control study. Cases (167) were all patients testing positive for C. difficile toxins A and B during 2009/2010 in the DHB’s hospitals. Two control subjects (334) testing negative were selected from the same database as the cases and matched for age, sex, and admission to the same medical specialty. Potential predictors of complications such as mortality before 30 days were assessed.

Results The median age was 73 years (range, 1–99 years). Overall 30-day mortality was 17% for the cases and 9% for the control subjects (P < 0.01). Males had an increased mortality (P < 0.01). Mortality was increased in untreated cases (P < 0.01) and cases with white blood cell (WBC) count outside the reference range (P < 0.01).

Conclusions Even in hospitals with a low CDI rate, there might be significant mortality in the older age group, with an increased risk of mortality in males and patients not treated for CDI.

From the *Microbiology Department, Canterbury Health Laboratories, and Infection Control Service, Canterbury District Health Board (CDHB), and †Infection Control Service, Christchurch Hospital, and ‡Infection Control Service, Burwood Hospital, Christchurch, New Zealand.

Correspondence to: Mona Schousboe, FRCPA, Canterbury Health Laboratories, CDHB, PO Box 151, Christchurch 8011, New Zealand. E-mail:

M.S. designed the research project and analyzed the data with assistance of the acknowledged public health analyst. R.B. and A.-M.W. collected data and provided infection control surveillance data and assisted with the text. All authors reviewed the manuscript.

All authors are employed by CDHB and have received no outside or extra support. They are employed as infection prevention and control staff at a CDHB’s Public Hospitals, and one author (the primary author) is also employed at the CDHB Hospital Laboratory Microbiology Department as a clinical microbiologist. The work was viewed as an audit for hospital-acquired infection.

© 2013 by Lippincott Williams & Wilkins.