S2107 Predictors of Clostridioides difficile Infection in Hospitalized Patients With End-Stage Renal Disease: Insights From a Large Cohort Study

Introduction: Clostridioides difficile infection (CDI) is a serious infection with increased morbidity and mortality. Patients with end-stage renal disease (ESRD) are at increased risk of developing CDI compared to the general population. We aim to assess the predictors of developing CDI specifically for this high-risk population. Methods: Using the Northwell HIE database from 2018 to 2021, we included a total of 11,259 hospitalized patients with end-stage renal disease. Demographics and clinical variables were collected. The primary endpoint was the development of C. difficile infection. Univariate analysis was performed to assess the association between the primary endpoint and each risk factor. Logistic regression adjusting for gender, age group, body mass index group, and race was performed for each risk factor in separate models. All statistical tests were 2-sided at a significance level of 0.05. Results: Of 11,259 hospitalized patients with ESRD (aged 65.1 ± 14.7 years; 60.3% men; 36.2% White), 246 (2.2%) developed CDI, while 11,013 (97.8%) did not. Univariate analysis identified several significant risk factors for CDI. Patients with autoimmune diseases were 86% more likely to develop CDI (odds ratio [OR]: 1.86, 95% confidence interval [CI]: 1.00–3.45). Patients with ferritin levels greater than 1000 µg/dL were 59% more likely to develop CDI (OR: 1.59, 95% CI: 1.10–2.29). Antibiotic use increased CDI risk by 149% (OR: 2.49, 95% CI: 1.93–3.21). Logistic regression analyses adjusting for gender, age group, body mass index group, and race, identified significant predictors: dialysis, autoimmune disease, high ferritin levels, and antibiotic use. Dialysis increased CDI risk by 69% (OR: 1.69, 95% CI: 1.12–2.56). High ferritin levels (>1000) increased CDI risk by 74% (OR: 1.735, 95% CI: 1.149-2.619). Autoimmune disease doubled the risk of developing CDI (OR: 2.136, 95% CI: 1.059-4.308). Antibiotic use nearly tripled CDI risk (OR: 2.90, 95% CI: 2.16–3.90). Conclusion: We identified several significant predictors of C. difficile infection in hospitalized patients with end-stage renal disease, including dialysis, autoimmune disease, elevated ferritin levels, and antibiotic use. These findings emphasize the need for targeted risk mitigation strategies in patients with ESRD, particularly when they have high-risk clinical profiles.