Clostridioides difficile Infection Among Hospitalized Patients With Cancer

TL;DR

Clostridioides difficile infection (CDI) occurs in about 1.4% of cancer-related hospitalizations in the US and is linked to higher mortality and increased use of critical care interventions.

Contribution

The study provides national-level data on CDI prevalence and outcomes in cancer patients, highlighting the need for targeted prevention strategies.

Findings

CDI occurred in 1.4% of cancer-related hospitalizations and was associated with a 62% higher adjusted odds of in-hospital mortality.

Patients with CDI had significantly higher rates of critical care interventions like mechanical ventilation and vasopressor use.

Mortality from CDI varied geographically, with the highest rates in the Northeast.

Abstract

This cross-sectional study evaluates the hospitalization-level prevalence, clinical outcomes, and health care resource utilization associated with Clostridioides difficile infection among hospitalized patients with cancer in the US.

What are the hospitalization-level prevalence and associated clinical outcomes of Clostridioides difficile infection (CDI) among cancer-related admissions in the US?

In this cross-sectional study of over 32 million cancer-related hospitalizations, 1.4% involved a diagnosis of CDI. Patients with CDI had higher in-hospital mortality (7.3% vs 4.5%) and greater use of critical care interventions. CDI was independently associated with a 62% increase in adjusted odds of mortality.

These findings suggest CDI is associated with adverse outcomes among hospitalized patients with cancer and may warrant targeted prevention strategies across high-risk malignant tumor types.

Patients with cancer face an increased risk of Clostridioides difficile infection (CDI) due to several factors, including chemotherapy and repeated health care exposures. However, recent national-level data characterizing the prevalence of CDI, associated clinical outcomes, and resource utilization in this population remain limited.

To characterize the hospitalization-level prevalence, clinical outcomes, and health care resource utilization associated with CDI among hospitalized patients with cancer in the US.

This cross-sectional study used data from the National Inpatient Sample, a nationally representative database, to identify hospitalizations among adults with a diagnosis of cancer between January 1, 2016, and December 31, 2022. Hospitalizations with CDI were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Data were analyzed from May to June 2025.

Presence of CDI as a primary or secondary diagnosis during the index hospitalization.

The primary outcome was in-hospital, all-cause mortality. Secondary outcomes included need for kidney replacement therapy, mechanical ventilation, vasopressor support, and colonoscopy. Multivariable logistic regression was used to adjust for demographics, comorbidities, cancer type, and hospital characteristics.

Of 32 083 671 cancer-related hospitalizations (overall study population mean [SD] patient age, 69.4 [13.9] years; 16 050 025 [50.0%] male), 450 360 (1.4%) involved a diagnosis of CDI. Compared with hospitalizations without CDI, those with CDI involved older patients, a higher proportion of women, and higher prevalence of hematologic cancers, cirrhosis, solid organ transplant, bone marrow transplant, chronic kidney disease, and inflammatory bowel disease. Patients with CDI infection had higher in-hospital mortality (7.3% vs 4.5%; adjusted odds ratio [aOR], 1.62; 95% CI, 1.58-1.67) and greater use of critical care interventions. CDI was associated with higher rates of critical care interventions, including kidey replacement therapy (44.3 vs 20.4 per 1000 hospitalizations; aOR, 2.00; 95% CI, 1.92-2.08; P < .001), mechanical ventilation (68.1 vs 35.6 per 1000 hospitalizations; aOR, 1.89; 95% CI, 1.84-1.95; P < .001), and vasopressor use (25.6 vs 11.5 per 1000 hospitalizations; aOR, 2.11; 95% CI, 2.00-2.24; P < .001). Mortality among patients with CDI varied geographically, ranging from 6.4% (95% CI, 6.2%-6.5%) in the Midwest to 8.5% (95% CI, 8.3%-8.7%) in the Northeast.

In this cross-sectional study of US oncologic hospitalizations, CDI occurred in 1 in 70 cancer-related hospitalizations and was associated with significantly increased mortality and resource utilization. These findings underscore the need for targeted prevention and early intervention strategies in this vulnerable population.

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