Higher Mortality Rates Associated with Clostridioides difficile Infection in Hospitalized Children with Cystic Fibrosis

Objective: (s): To determine the impact of Clostridioides difficile  Infection (CDI) among pediatric Cystic Fibrosis (CF) hospitalizations using a large nationally representative pediatric hospital database . Study design: We identified Cystic Fibrosis-related hospitalizations during the years 1997 to 2016 in the Kids’ Inpatient Database [KID] and compared in-hospital mortality, Length of Stay [LOS], and hospital charges among hospitalizations with and without a coexisting diagnosis of C. difficile using logistic regression models for mortality and general linear models with gamma distribution and logarithmic transformation for LOS and hospital charges. We also evaluated temporal trends in the proportion of CF hospitalizations with concomitant CDI using data published triennially Results: : We analyzed 21, 616 pediatric CF hospitalizations between the years 1997 to 2016 and found a total of 240 (1.1%) hospitalizations with concurrent CDI diagnosis. Adjusted analyses demonstrated an association of CDI with increased mortality (OR 5.2, 95% 95% CI 2.5-10.7), longer LOS (46.5% increment, 95% CI 36.0-57.1), and higher charges (65.8% increment, 95% CI 53.5-78.1) for all comparisons. The proportion of CF hospitalizations with CDI increased over time from 0.64% in 1997 to 1.73% in 2016 (p<0.001). Conclusion: (s): As CDI is associated with excess mortality, LOS, and cost in children hospitalized for CF, efforts to reduce infection rates and aggressive diagnosis and treatment of active infections should be prioritized to improve hospital outcomes among children with CF.