Clostridium difficile infection in hospitalized liver transplant patients: a nationwide analysis.

Incidence of Clostridium difficile infection (CDI) is increasing among hospitalized patients. Liver transplant patients are at higher risk for acquiring CDI. Small, single-center studies, but no nation-wide analyses, have assessed this association. We used the Healthcare Cost and Utilization Project- Nationwide Inpatient Sample (HCUP-NIS) from years 2004–2008 for this retrospective cross sectional study. Patients with any discharge diagnosis of liver transplant comprised the study population and were identified using ICD-9-CM codes. Those with a discharge diagnosis of CDI were considered cases. Our primary outcomes were prevalence of CDI and effect of CDI on inpatient mortality. Our secondary outcomes included length of stay and hospitalization charges. Regression analysis was used to derive odds ratios adjusted for potential confounders. There were 193,714 discharges with a diagnosis of liver transplant from 2004–2008. Prevalence of CDI was 2.7% in liver transplant population compared to 0.9% in non liver transplant population (p <0.001). Most of the liver transplant patients were in the 50–64 age group. Liver transplant patients were at higher odds of developing CDI (OR 2.88, 95% CI 2.68–3.10). Increasing age, increasing comorbidity, IBD and NG tube placement were also independent risk factors for CDI. CDI in liver transplant was associated with a higher mortality, 5.5% as compared to 2.3% in liver transplant only population (adjusted OR 1.7, 95% CI 1.3–2.2). Liver transplant patients have a higher prevalence of CDI as compared to non liver transplant patients (2.7% vs. 0.9%).CDI was an independent risk factor for mortality in liver transplant population.

艰难梭菌感染（CDI）在住院患者中的发病率正在上升。肝移植患者感染CDI的风险更高。一些小型的单中心研究评估了这种关联，但尚无全国性的分析。 我们使用2004 - 2008年的医疗保健成本和利用项目 - 全国住院患者样本（HCUP - NIS）进行这项回顾性横断面研究。任何出院诊断包含肝移植的患者构成研究人群，并使用国际疾病分类第九版临床修订本（ICD - 9 - CM）编码进行识别。那些出院诊断为CDI的患者被视为病例。我们的主要观察指标是CDI的患病率以及CDI对住院患者死亡率的影响。我们的次要观察指标包括住院时间和住院费用。回归分析用于得出针对潜在混杂因素调整后的比值比。 2004 - 2008年期间，有193714例出院诊断为肝移植的患者。肝移植人群中CDI的患病率为2.7%，而非肝移植人群中为0.9%（p <0.001）。大多数肝移植患者处于50 - 64岁年龄组。肝移植患者发生CDI的几率更高（比值比2.88，95%置信区间2.68 - 3.10）。年龄增长、合并症增多、炎症性肠病（IBD）以及鼻胃管置入也是CDI的独立危险因素。肝移植患者中的CDI与更高的死亡率相关，为5.5%，而仅肝移植患者人群中的死亡率为2.3%（调整后的比值比1.7，95%置信区间1.3 - 2.2）。 与非肝移植患者相比，肝移植患者的CDI患病率更高（2.7%对0.9%）。CDI是肝移植人群死亡的独立危险因素。