Abstract 5: Heart Failure Patients Hospitalized with Bacterial Infections: A Nationwide Analysis of Concomitant Clostridium Difficile Infection Rates and In-Hospital Mortality

Heart failure (HF) patients have altered gut microbiota, as do patients who receive antibiotics for bacterial infections. Altered gut microbiota is associated with increased susceptibility to C. difficile infection (CDI). It is not known if HF patients hospitalized with bacterial infections experience CDI more frequently and whether CDI impacts their mortality. We utilized Healthcare Cost and Utilization Project National Inpatient Sample data from 2010 to 2012 to determine the rate of CDI and associated in-hospital mortality for HF patients hospitalized with urinary tract infection (UTI), pneumonia (PNA) or sepsis. Univariate and multivariate analyses were performed. Unweighted data are presented. We identified 868,401 HF patients hospitalized with UTI, PNA, or sepsis. There were 2,825,390 patients without HF hospitalized with the same infections. HF patients were on average older (75.4 vs 65.1 years, p<0.001) compared to patients without HF. In unadjusted analysis, HF patients hospitalized with UTI, PNA or sepsis had higher rates of CDI compared to patients without HF hospitalized with the same infections (UTI 3.9% vs 2.7%, PNA 2.9% vs 2.3%, sepsis 6.8% vs 5.3%; p<0.001 for all). Heart failure remained significantly associated with CDI (OR 1.2, 95% CI 1.18-1.23, p<0.001), even after controlling for patient demographics, insurance status, hospital characteristics, and presence of ischemic heart disease. Heart failure patients hospitalized with UTI, PNA or sepsis and diagnosed with CDI had higher in-hospital mortality rates compared to HF patients hospitalized with UTI, PNA or sepsis who did not develop CDI (figure). CDI remained significantly associated with in-hospital mortality for HF patients hospitalized with bacterial infections (OR 2.0, 95% CI 1.9-2.1, p<0.001), even after controlling for the above variables. Heart failure is associated with higher rates of CDI among patients hospitalized with common bacterial infections, even when adjusting for other known risks for CDI. Furthermore, within the HF population, CDI is associated with markedly higher in-hospital mortality. These findings suggest an opportunity to improve outcomes for HF patients through improved C. difficile screening and prophylaxis protocols. ![][1] [1]: /embed/graphic-1.gif