A Propensity Score Analysis of Clostridium Difficile Infection Among Adult Trauma Patients.

Author(s):
Viktor Gabriel; Eugene Won; Jacquelyn Phillips; Chloe Krasnoff; Areg Grigorian; Cristobal Barrios; Sebastian Schubl; Marija Pejcinovska; Jeffry Nahmias

Background:

Clostridium difficile infection (CDI) is now the most common cause of healthcare associated infection and carries a mortality rate ranging from 5-30%. Previously, trauma patients developing CDI were thought to represent a unique younger at-risk population. This study aimed to establish the incidence of CDI among adult trauma patients.

Hypothesis:

We hypothesized these patients would have increase risk of mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS.

Methods:

A retrospective study on trauma patients admitted between 2014-2016 for greater than 48 hours was conducted. Analysis was carried out using 1-to-5 propensity score matching. Propensity score matching was used to analyze the relationship between CDI, mortality and other outcome variables.

Results:

Out of 12,706 trauma patients, 27 patients (0.21%) were diagnosed with CDI between 2014-2016. These patients had a mean age of 55.6, mean injury severity score (ISS) of 22.4 (see Table 1) and mortality rate of 9.1%. Of these patients, 22 were able to find appropriate propensity score matches. After adjusting for important covariables, there was no significant difference in mortality between CDI and non-CDI patients (OR=0.39, 95% CI: 0.06-2.57, adjusted p 0.66). Additionally, there was no significant difference in ICU LOS between the two groups (relative mean (RM): 1.55, 95% CI: 1.04-2.33, adjusted p 0.09). However, CDI patients did have a significantly longer hospital LOS, as compared to non-CDI patients (RM=1.39, 95% CI: 1.16-1.66, adjusted p <0.01).

Conclusions:

CDI infection occurred at a much lower rate than anticipated, 0.21%  of trauma patients admitted >48hours. Patients developing CDI had a significantly longer hospital LOS. There was no significant difference in odds of mortality or ICU LOS.