Clinical burden of Clostridioides difficile infection in infective endocarditis: a single-center experience

Clostridioides difficile infection (CDI) is a leading cause of diarrhea in hospitalized patients and there are no studies addressing its burden in patients with acute infective endocarditis (IE). We aimed to assess the incidence and clinical correlates of CDI occurring during hospitalization for acute bacterial IE and analyzed the prognostic impact of this complication. A single-center retrospective study was conducted including patient hospitalized for acute IE between 2016 and 2024. CDI was defined as acute-onset diarrhea, followed by positive stool test. Analyses were based on the comparison of CDI and non-CDI cases in the subgroup of patients developing diarrhea during hospitalization. We enrolled 370 IE cases with a median age of 65 [53-74] years and most were male (68.1%). 50 (13.4%) developed diarrhea during hospitalization, of which 10 (20%) had a positive stool test and were considered CDI cases. The resultant incidence of CDI in the study period was 17.04 cases for 10,000 patient bed-days. CDI-positive patients showed an independent increased risk of in-hospital mortality (HR 3.34 [1.014-11.058]; p = 0.047). CDI incidence in our cohort of patients hospitalized for acute IE was high and associated to a reduced survival, with CDI cases showing a higher in-hospital mortality rate. Our findings underline the need for prevention and rapid detection of CDI in this setting.