Impact of Clostridiodes difficile Infection on Outcomes of Acute Cholecystitis in Hospitalized Patients

Approximately 200,000 individuals are affected by acute cholecystitis (AC) annually. Mainstay treatment options for acute cholecystitis involve antibiotics and laparoscopic cholecystectomy. This may predispose patients to diarrhea from Clostridioides Difficile infection (CDI), a leading healthcare-associated infection. With this study, we aim to assess the influence of CDI on outcomes of hospitalized AC patients in the United States using the National Inpatient Sample (NIS) database. The NIS database was surveyed to account for all AC admissions in the US from 2016 to 2020. This data was later stratified into patients with CDI and without CDI. Outcomes included mortality, LOS, critical care needs, gallbladder complications, and procedural timing. We performed multivariate regression to identify the association between AC and CDI, as well as the risk factors for mortality in the AC and CDI cohort. We found that CDI was associated with a significant increase in mortality (8.45% vs 0.90%, p< 0.0001), LOS (16.32 vs 4.61days, p< 0.0001), increased critical care needs - ICU admission (14.66% vs 2.32%, p< 0.0001), mechanical ventilation (11.74% vs 1.94%, p< 0.0001), central venous catheter insertion (5.39% vs 0.52%, p< 0.0001), and vasopressor support (3.74% vs 0.75%, p< 0.0001). CDI was also associated with reduced same-admission cholecystectomy (45.85% vs 78.53%, p < 0.0001). Moreover, the CDI cohort was noted to have higher rates of cholecystostomy (20.49% vs 5.98%, p < 0.0001). Our study demonstrates that CDI is associated with significantly worse outcomes in hospitalized AC patients. Emphasis should be placed on early recognition of risk factors and antibiotic stewardship to mitigate the co-infection with CDI.