P3011 - Clostridioides difficile Infection in Stem Cell Transplant Recipients in Hospitalized Patients in the US

Tuesday, October 24, 2023

10:30 AM – 4:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Muhammad Haseeb, MD (he/him/his)

Brigham and Women's Hospital
Pittsburgh, PA

Muhammad Kamal, MD¹, Arafat Shabbir, MD², Umar Hayat, MD³, Maham Waqar, MBBS⁴, Sakina Abbas, ⁵, Asim Nadeem, MD⁶, Anum Khakwani, MBBS, FCPS⁷, Fnu Faheela, MBBS⁷, Zubair Khan, MD⁸, Muhammad Haseeb, MD⁹
¹Essen Health Care System, New York, NY; ²Yale New Haven Hospital, New Haven, CT; ³Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁴King Edward Medical University, Boston, MA; ⁵Dow Medical College, Karachi, Sindh, Pakistan; ⁶Baptist Medical Center South, Montgomery, AL; ⁷Nishtar Medical University, Multan, Punjab, Pakistan; ⁸Mercy Clinic, Poland, OH; ⁹Brigham and Women's Hospital, Boston, MA

Introduction: Clostridium difficile infection (CDI) causes increased morbidity and mortality rates in patients undergoing stem cell transplantation (SCT). Our study aimed to examine the risk of CDI in hospitalized patients undergoing SCT and its impact on resource utilization

Methods: National Inpatient Sample (NIS) database 2019 was queried for all adult patients admitted for auto- and allo-SCTs. A weighted sample was used to get baseline characteristics and resource utilization during the inpatient admissions. Multivariate logistic regression analyses were employed to identify the risk of CDI in both auto-SCT and allo-SCT patients. Resource utilization and mortality were assessed in SCT patients with and without CDI.

Results: The results demonstrated that auto-SCT accounted for 60.2% of all SCT procedures during the study period, with a CDI prevalence of 4.3% among auto-SCT patients and 8.3% among allo-SCT patients. Overall, less percentage of females underwent SCT (40.8%). The average age was higher in auto-SCT than allo-sct (57.3 years vs 52.6 years). Auto-SCT scored higher on Charlson Comorbidity Index (CCI) than allo-SCT, i.e., 2.86 vs. 2.18. Private insurance was the major insurer with a higher percentage for allo-SCT than auto-SCT (60.9% vs. 55.9%). Multivariate analysis showed that the odds of CDI in allo-SCT was 1.96 times higher than auto-SCT. Overall, SCT patients with CDI were associated with significantly longer length of stay (LOS) compared to those without, i.e., 28.5 (95% CI 25.9-31.02) vs. 22.2 (95% CI 21.3-23.1). This contributed to significantly higher hospital costs in this patient population with CDI. i.e., $567,380.4 (95% CI 466,851- 667,910) vs $375,563 (95% CI 332,670 – 418,456). Mortality was also higher in SCT with CDI (4.7% vs 2.4%). Multivariate analysis demonstrated that the adjusted odds ratio for mortality in SCT with CDI is 2.11 times higher than in SCT without CDI.

Discussion: Our study shows that CDI was more common in allo-SCT patients than auto-SCT patients. CDI is associated with adverse outcomes in this population and contributes to more extended hospital stays, higher healthcare costs, and increased mortality rates. This study provides insights into the population at higher risk for CDI and underscores the importance of implementing more effective preventive measures.

Variables	All SCT Patients (17940)	Auto-SCT Patients (10800)	Allo-SCT Patients (7145)	p-value
	a) Baseline Patient and Hospital Characteristics
Age (SD)	55.5(14.1)	57.3(12.9)	52.6(15.3)	< 0.01
Female (%)	7320 (40.8)	4305 (39.9)	3015(42.2)	0.16
Race (%)				< 0.01
White	12100(69.1)	7090 (67.5)	5015 (71.6)
CDI (%)	1055 (5.9)	465 (4.3)	590 (8.3)	< 0.01
Charlson Comorbidity Index (SD)	2.59 (0.03)	2.86 (1.5)	2.18 (0.04)	< 0.01
Hospital Type (%)
Urban	17885 (99.7)	10760 (99.6)	7130(99.8)	0.28
Teaching	17855(99.5)	10745 (99.5)	7115 (99.6)	0.72
Hospital Bed Size (Large)	13600 (75.8%)	8275 (76.6)	5325(74.5)	0.69
Payer Information (%)				< 0.01
Medicare	5030(29.2)	3330 (31.9)	1700 (24.9)
Private Insurance	9970 (57.9)	5820 (55.9)	4155 (60.9)
	Unadjusted and Adjusted* Odds for CDI in Allo-SCT with Auto-SCT as reference
Unadjusted Adjusted	2.00 (95% CI 1.49-2.68) 1.96 (95% CI 1.44-2.69)			< 0.01 < 0.01

	SCT with CDI (1055)	SCT without CDI (16885)
Disposition (%)			< 0.01
Home SNF AMA Died	70(71.1%) 50 (4.7) 0 (0) 50 (4.7)	13200(78.2) 360 (2.1) 10 (0.09) 400 (2.4)
LOS (days)	28.5 (95% CI 25.9-31.02)	22.2 (95% CI 21.3-23.1)	< 0.01
Total Charges ($)	567380.4 (95% CI 466850.5- 667910.3)	375562.8 .7 (95% CI 332670.1 - 418455.5)	< 0.01
	Unadjusted and Adjusted* Odds for Mortality in SCT population with CDI than without.
Unadjusted Adjusted	2.05 (95% CI 1.13-3.71) 2.11 (95% CI 1.18-3.8)		< 0.01 0.01
CDI, Clostridium difficile infection; auto-SCT, autologous stem cell transplant; Allo-SCT, allogeneic stem cell transplant; LOS, Length of stay. *Adjusted for Age, Gender, Race, Charlson Comorbidity Index, Hospital (Teaching Status, Bed Size)

Disclosures:

Muhammad Kamal indicated no relevant financial relationships.

Arafat Shabbir indicated no relevant financial relationships.

Umar Hayat indicated no relevant financial relationships.

Maham Waqar indicated no relevant financial relationships.

Sakina Abbas indicated no relevant financial relationships.

Asim Nadeem indicated no relevant financial relationships.

Anum Khakwani indicated no relevant financial relationships.

Fnu Faheela indicated no relevant financial relationships.

Zubair Khan indicated no relevant financial relationships.

Muhammad Haseeb indicated no relevant financial relationships.

Muhammad Kamal, MD¹, Arafat Shabbir, MD², Umar Hayat, MD³, Maham Waqar, MBBS⁴, Sakina Abbas, ⁵, Asim Nadeem, MD⁶, Anum Khakwani, MBBS, FCPS⁷, Fnu Faheela, MBBS⁷, Zubair Khan, MD⁸, Muhammad Haseeb, MD⁹. P3011 - Clostridioides difficile Infection in Stem Cell Transplant Recipients in Hospitalized Patients in the US, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.