Increased Incidence and Risk of Septicemia and Urinary Tract Infection After

Background

Although increased occurrence of septicemia in persons with

Methods

The first episode of CDI was identified using 2011-2017 MarketScan and CMS Medicare data and CDI cases categorized by standard surveillance definitions. Uninfected persons were frequency matched 4:1 to cases by the CDI case surveillance definition. Multivariable Cox proportional hazards models were used to identify risk factors for septicemia and UTI within 90 days of CDI onset, accounting for the competing risk of death in the Medicare population.

Results

The incidence of septicemia was highest after hospital-onset CDI in the Medicare, younger commercial, and younger Medicaid populations (25.5%, 15.7%, and 19.5%, respectively) and lowest in those with community-associated CDI (3.8%, 4.3%, and 8.3%, respectively). In contrast, the incidence of UTI was highest in those with other healthcare facility onset CDI in all 3 populations (32.1%, 24.2%, and 18.1%, respectively). Hospital-onset CDI was associated with highest risk of septicemia compared with uninfected controls in all 3 populations. In the younger populations, risk of septicemia was more uniform across the CDI surveillance definitions. The risk of UTI was significantly higher in all CDI surveillance categories compared to uninfected controls, and among CDI cases it was lowest in those with community-associated CDI.

Conclusions

The incidence of septicemia is high after CDI, particularly after hospital-onset infection. Additional preventive measures are needed to reduce infectious complications of CDI.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Déclaration de conflit d'intérêts

Potential conflicts of interest. The sponsor participated in study design, interpretation of the data, and final review of the manuscript. MAO reports personal fees from Pfizer for consulting work. ERD reports receipt of grant funding from Pfizer, Synthetic Biologics, and Ferring in the past 36 months and personal fees from Ferring, Rebiotix, Summit, Merck, Pfizer, and Seres. HY is an employee of Pfizer, Inc. and has stock or stock options for Pfizer. DS reports stock or stock options from AbbVie, Inc., and Bristol-Myers Squibb. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.