S2050 Clinical Outcomes of Female Patients With Clostridioides difficile Infection: A Retrospective Cohort Study

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 affects both sexes, emerging evidence suggests there may be sex-based differences in disease outcomes, potentially due to hormones, variations in immune response, and differences in healthcare utilization. There is limited data specifically for outcomes of female patients with Clostridioides difficile. 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 female adult patients 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 218,217 (54.3%) patients were women. The inpatient mortality analysis from the dataset reveals that 12,447 female patients with CD infection died during hospitalization, accounting for approximately 51.7% of all inpatient deaths (24,068 total deaths). Multivariate regression showed that female patients with CD infection had higher inpatient mortality when compared to their male counterparts (odds ratio [OR] 2.071, confidence interval [CI] 2.044–2.098, P < 0.001). On secondary analysis, it has shown that women with CD had higher odds of having shock of any type (OR 1.884, CI 1.854-1.915, P < 0.001), vasopressor use (OR 1.983, CI 1.944-2.023, P < 0.001), and acute kidney failure (OR 2.013, CI 2.002-2.024, P < 0.001). Conclusion: In this nationally representative population-based retrospective cohort study, female patients had higher mortality and worse outcomes among patients who are diagnosed with an infection with CD. These findings suggest that female sex may be an independent risk factor for worse outcomes in CD infection. Further investigation is warranted to explore potential biological, clinical, or healthcare access-related factors contributing to this disparity.