The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

Clinical Quality and Performance Management, Ottawa Hospital, Ottawa, Ontario, Canada.
Archives of internal medicine (Impact Factor: 17.33). 11/2010; 170(20):1804-10. DOI: 10.1001/archinternmed.2010.405
Source: PubMed


The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission.
This retrospective observational study used data from the Ottawa Hospital (Ottawa, Ontario, Canada) data warehouse. Inpatient admissions with a start date after July 1, 2002, and a discharge date before March 31, 2009, were included. Stratified analyses and a Cox multivariate proportional hazards regression model were used to determine if hospital-acquired CDI was associated with time to in-hospital death.
A total of 136 877 admissions were included. Hospital-acquired CDI was identified in 1393 admissions (overall risk per admission, 1.02%; 95% confidence interval [CI], 0.97%-1.06%). The risk of hospital-acquired CDI significantly increased as the baseline mortality risk increased: from 0.2% to 2.6% in the lowest to highest deciles of baseline risk. Hospital-acquired CDI significantly increased the absolute risk of in-hospital death across all deciles of baseline risk (pooled absolute increase, 11%; 95% CI, 9%-13%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI (95% CI, 2.4-3.7); this hazard ratio decreased with increasing baseline mortality risk.
Hospital-acquired CDI was independently associated with an increased risk of in-hospital death. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.

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    • "We are testing our approach in a Clinical Intelligence scenario dedicated to the surveillance for, and research on Hospital-Acquired Infections (HAI). To this end, we are prototyping a SADI-based infrastructure for semantic querying of a relational database used by The Ottawa Hospital (TOH) and containing an extract from the large TOH datawarehouse accumulating data from the most important IT systems of the hospital (see, e.g., [21,22]). Our infrastructure consists of an ontology defining concepts suitable for reasoning about Hospital-Acquired Infections, and a number of SADI services drawing data from the DB, as well as several general purpose services dealing with information about drugs, diseases and infectious agents. "
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