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Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019: a population-based cohort study
Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm, 171 65, Sweden.
Centre for Translational Microbiome Research (CTMR), Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Solnavägen 9, Stockholm, 171 65, Sweden.
Global Health Economics & amp; Outcomes Research at Ferring Pharmaceuticals, Copenhagen, Denmark.
Department of Family Medicine and Population Health, Antwerp University, Antwerp, Belgium.
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2024 (English)In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 24, no 1, article id 468Article in journal (Refereed) Published
Abstract [en]

Background: Clostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community). Methods: This Swedish nationwide population-based cohort study (2006–2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up. Results: Overall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40–18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16–9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84–4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31–3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12–1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68–7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07–8.26). Conclusion: CDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024. Vol. 24, no 1, article id 468
Keywords [en]
Burden, Clostridioides difficile, Health-economic, Healthcare consumption, Real world evidence, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Clostridium Infections, Cohort Studies, Cross Infection, Female, Hospitalization, Humans, Incidence, Infant, Length of Stay, Male, Middle Aged, Patient Acceptance of Health Care, Recurrence, Sweden, Young Adult, acetylsalicylic acid, antibiotic agent, histamine H2 receptor antagonist, nonsteroid antiinflammatory agent, proton pump inhibitor, Article, Charlson Comorbidity Index, Clostridium difficile infection, cohort analysis, comorbidity, disease burden, follow up, health care access, hospital admission, human, major clinical study, outcome assessment, outpatient, prescription, recurrent disease, risk factor, Clostridium infection, patient attitude, preschool child, very elderly
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:hj:diva-64170DOI: 10.1186/s12879-024-09364-3ISI: 001214184600003PubMedID: 38702635Scopus ID: 2-s2.0-85191974042Local ID: GOA;intsam;950589OAI: oai:DiVA.org:hj-64170DiVA, id: diva2:1857356
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Karolinska InstituteAvailable from: 2024-05-13 Created: 2024-05-13 Last updated: 2025-01-22Bibliographically approved

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