P3018 - Trends in Clostridioides difficile-Related Hospitalizations Among Patients With Solid Organ Transplant in the United States 2011-2020

Tuesday, October 24, 2023

10:30 AM – 4:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Abdelkader Chaar, MD

Yale University School of Medicine
New Haven, Connecticut

AbdelKader Chaar, MD¹, Yazan Abboud, MD², Rabia Rizwan, MD¹, Ahmad Nawaz, MD¹, Shanti Patel, MD¹, Paul Feuerstadt, MD, FACG³
¹Yale University School of Medicine, New Haven, CT; ²Rutgers New Jersey Medical School, Newark, NJ; ³PACT Gastroenterology Center and Yale School of Medicine, Hamden, CT

Introduction: Recent studies suggest that solid organ transplant (SOT) is associated with worse outcomes in Clostridioides difficile infection (CDI), but little is known about healthcare utilization in this population. In this study, we investigated trends of CDI-related admissions among patients with SOT over the last decade in the United States (US).

Methods: We performed a retrospective cohort study using the National Inpatient Sample database from 2011 to 2020 of hospitalized patients with primary discharge diagnoses of CDI. Time-trends for patients with history of solid organ transplant (SOT) and those without SOT (nonSOT) were estimated using Joinpoint Regression Software (v. 4.9.0.1, National Cancer Institute “NCI”), which uses Monte Carlo permutation analysis to generate the simplest segmented line that reflects change of variable over time. Trends were reported as annual percentage change (APC) and average APC (AAPC).

Results: There were 2202 CDI-related hospitalizations in patients with SOT in the US between 2011-2020. The incidence rates of CDI in SOT patients were higher than in non-CDI across all years. Incidence rates of CDI were significantly decreasing in SOT patients (AAPC=-3.30, p=0.02) and in nonSOT (AAPC=-6.20, p< 0.001) over the study period. Mortality rates were significantly decreasing in SOT patients (APC=-30.29, p=0.01) and in nonSOT (APC=-12.79, p< 0.001) between 2011-2016. However, between 2016-2020, there was a trend showing an increase in mortality among SOT (Table and Figure). When averaged over the last decade, mortality rates decreased in nonSOT (AAPC=-7.74, p< 0.001) but not for SOT patients (AAPC=-4.78, p=0.587). Length of stay has been decreasing in nonSOT (AAPC -1.37, P=0.001) but not in SOT patients (AAPC=-1.53, p=0.08). Total charges were significantly decreasing between 2011-2016 in both groups (nonSOT APC=-1.73, p=0.007; SOT APC=-6.17, p=0.002), then significantly increasing between 2016-2020 (APC= 2.46, p=0.004 vs 6.71, p=0.001).

Discussion: Our analysis of US nationwide data showed decreasing CDI-specific hospitalizations in both SOT and nonSOT over the prior decade; CDI hospitalization rates in SOT were more than double those of nonSOT across all years. Although mortality and healthcare utilization metrics decreased from 2011 to 2016, there appears to be an alarming, yet non-significant, recent increase in SOT patients. Further studies are needed to identify factors contributing to these changes.

Figure: Figure: Trends in Clostridioides difficile-related hospitalizations in the US stratified based on solid organ transplant status.

Population	Trends
	Time period	APC (95% CI)	AAPC (95% CI)
Incidence
Non-Transplant	2011-2020	-6.20 (-8.51 to -3.84); p< 0.001	-6.20 (-8.51 to -3.84); p< 0.001
Transplant	2011-2020	-3.30 (-6.03 to -0.50); p=0.027	-3.30 (-6.03 to -0.50); p=0.026
Mortality
Non-Transplant	2011-2016	-12.79 (-16.55 to -8.87); p< 00.1	-7.74 (-11.14 to -4.22); p< 0.001
	2016-2020	-1.02 (-10.07 to 8.95); p=0.795
Transplant	2011-2016	-30.29 (-45.40 to -10.99); p=0.013	-4.78 (-19.87 to 13.16); p=0.578
	2016-2020	40.62 (-6.46 to 111.38); p=0.084
Length of Stay
Non-Transplant	2011-2018	-2.37 (-2.92 to -1.83); p< 0.001	-1.37 (-2.20 to -0.54); p=0.001
	2018-2020	2.22 (-2.34 to 7.00); p=0.271
Transplant	2011-2017	-4.81 (-6.70 to -2.87); p=0.001	-1.53 (-3.27 to 0.23); p=0.088
	2017-2020	5.36 (-0.50 to 11.55); p=0.066
Total Hospital Charges
Non-Transplant	2011-2016	-1.73 (-2.72 to -0.73); p=0.007	0.11 (-0.49 to 0.72); p=0.713
	2016-2020	2.46 (1.17 to 3.77); p=0.004
Transplant	2011-2016	-6.17 (-8.83 to -3.44); p=0.002	-0.65 (-2.11 to 0.83); p=388
	2016-2020	6.71 (4.10 to 9.39); p=0.001

Disclosures:

AbdelKader Chaar indicated no relevant financial relationships.

Yazan Abboud indicated no relevant financial relationships.

Rabia Rizwan indicated no relevant financial relationships.

Ahmad Nawaz indicated no relevant financial relationships.

Shanti Patel indicated no relevant financial relationships.

Paul Feuerstadt: Ferring/Rebiotix, Inc. – Advisory Committee/Board Member, Consultant, Speakers Bureau. Merck & Co. – Consultant, Speakers Bureau. Seres Therapeutics – Advisory Committee/Board Member, Consultant, Speakers Bureau. Takeda Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speakers Bureau.

AbdelKader Chaar, MD¹, Yazan Abboud, MD², Rabia Rizwan, MD¹, Ahmad Nawaz, MD¹, Shanti Patel, MD¹, Paul Feuerstadt, MD, FACG³. P3018 - Trends in Clostridioides difficile-Related Hospitalizations Among Patients With Solid Organ Transplant in the United States 2011-2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.