S2052 A Nationwide Analysis of Smoking and Hospitalization Outcomes in Clostridioides difficile Infection

Introduction: Clostridioides difficile (CD) is a spore-forming, toxin-producing bacterium that causes diarrhea and colitis, often in hospitalized or immunocompromised individuals. While CD infection can affect individuals regardless of smoking history, smoking has been associated with alterations in immune function, microbiome disruption, and increased susceptibility to infectious diseases. Emerging evidence suggests that patients with a history of smoking may experience different clinical outcomes when hospitalized with CD infection. However, data specific to this population remain limited. We sought to examine the national inpatient sample database to describe in-hospital outcomes among these patients. Methods: Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015 to 2022. The NIS searched for hospitalizations of adult patients with active tobacco use with documented CD infections using the International Classification of Diseases, Tenth Revision codes. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. SPSS software was used for statistical analysis. Results: This study included 402,061 with CD infection, of which 80,883 (20.1%) patients with active tobacco use at the time of their hospitalization. Multivariate regression showed that patients who smoke with CD infection had higher inpatient mortality when compared to nonsmokers (odds ratio [OR] 1.167, confidence interval [CI] 1.161–1.173, P < 0.001). On secondary analysis, it has shown that smokers with CD had higher odds of having shock of any type (OR 1.149, CI 1.142-1.157, P < 0.001), vasopressor use (OR 1.145, CI 1.137-1.154, P < 0.001), and acute kidney failure (OR 1.236, CI 1.233-1.239, P < 0.001). These patients were also found to have higher rates on admission of chronic pulmonary disease (OR 1.407, CI 1.401-1.414, P < 0.001), chronic kidney disease (OR 1.268, CI 1.264-1.272, P < 0.001), and hypertension (OR 1.276, CI 1.272-1.279, P < 0.001). Conclusion: In this nationally representative population-based retrospective cohort study, patients with a history of smoking had higher inpatient mortality and worse clinical outcomes among those diagnosed with CD infection. These findings suggest that smoking may be an independent risk factor for adverse outcomes in CD infection. Further investigation is warranted to explore the underlying mechanisms, including the impact of smoking on immune function, microbiome integrity, and response to infection.