A Propensity Score Analysis of Clostridium Difficile Infection Among Adult Trauma Patients.

Viktor Gabriel; Eugene Won; Jacquelyn Phillips; Chloe Krasnoff; Areg Grigorian; Cristobal Barrios; Sebastian Schubl; Marija Pejcinovska; Jeffry Nahmias

Clostridium difficile infection (CDI) is now the most common cause of healthcare associated infection and carries a mortality rate ranging from 5-30%. Previously, trauma patients developing CDI were thought to represent a unique younger at-risk population. This study aimed to establish the incidence of CDI among adult trauma patients.

We hypothesized these patients would have increase risk of mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS.

A retrospective study on trauma patients admitted between 2014-2016 for greater than 48 hours was conducted. Analysis was carried out using 1-to-5 propensity score matching. Propensity score matching was used to analyze the relationship between CDI, mortality and other outcome variables.

Out of 12,706 trauma patients, 27 patients (0.21%) were diagnosed with CDI between 2014-2016. These patients had a mean age of 55.6, mean injury severity score (ISS) of 22.4 (see Table 1) and mortality rate of 9.1%. Of these patients, 22 were able to find appropriate propensity score matches. After adjusting for important covariables, there was no significant difference in mortality between CDI and non-CDI patients (OR=0.39, 95% CI: 0.06-2.57, adjusted p 0.66). Additionally, there was no significant difference in ICU LOS between the two groups (relative mean (RM): 1.55, 95% CI: 1.04-2.33, adjusted p 0.09). However, CDI patients did have a significantly longer hospital LOS, as compared to non-CDI patients (RM=1.39, 95% CI: 1.16-1.66, adjusted p <0.01).

CDI infection occurred at a much lower rate than anticipated, 0.21%  of trauma patients admitted >48hours. Patients developing CDI had a significantly longer hospital LOS. There was no significant difference in odds of mortality or ICU LOS.