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Clostridium difficile infection in hospitalized patients with COPD in Spain (2001–2015)

      Highlights

      • Incidence of CDI is increasing overtime (2001–15) in patients with and without COPD.
      • Incidence of CDI was twice higher in COPD patients than in matched non-COPD controls.
      • IHM decreased significantly over time in patients without COPD.
      • For COPD patients IHM remained stable over time.
      • IHM is higher among COPD patients with a secondary diagnosis of CDI.

      Abstract

      Background

      The objectives of this study were to examine incidence and in-hospital outcomes of Clostridium difficile infection (CDI) among patients with COPD, to compare clinical variables among COPD patients with matched non-COPD patients hospitalized with CDI, and to identify factors associated with in-hospital mortality (IHM) among COPD patients.

      Methods

      We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients aged 40 years or over with a primary or secondary diagnosis of CDI. For each COPD patient, we selected a sex, age, readmission status and year-matched non-COPD patient.

      Results

      We identified 44,695 patients with CDI (19.36% with COPD). Incidence of CDI has increased significantly from 2001 to 2015 besides COPD status. Incidence was higher in COPD patients than in patients without this disease (IRR 2.24; 95%CI 2.18–2.29). IHM decreased significantly over time in patients without COPD (from 13.98% in 2001–03 to 10.99% in 2013–15), but there were no changes in those with COPD (from 12.93% in 2001–03 to 13.37% in 2013–15). In COPD patients, higher mortality rates were associated with older age, comorbidities, severe CDI, longer length of hospital stay and readmission. Primary diagnosis of CDI was associated with lower IHM in this group of patients (OR 0.66; 95%CI 0.56–0.77) in comparison with secondary diagnosis.

      Conclusions

      Incidence of CDI was twice higher in COPD patients than in matched non-COPD controls and is increasing overtime in both groups. Our results suggest that the management of CDI has improved in Spain during the study period.

      Keywords

      Abbreviations:

      CCI (Charlson comorbidity index), CDI (Clostridium difficile Infection), ICD-9-CM (International Classification Disease-9-Clinical Modification), GRD (Diagnosis-Related Groups), IHM (in-hospital mortality), IRR (Incidence Rate Ratio), LOHS (length of hospital stay), OR (Odds Ratio), SNHDD (Spanish National Hospital Discharge Database)
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