Prevalence, associated factors, and outcomes of Clostridioides difficile infection across gastrointestinal cancer subtypes: a US nationwide analysis

Abstract Purpose This study aimed to evaluate the prevalence, factors associated with, and clinical and healthcare impact of Clostridioides difficile infection (CDI) among hospitalized adults with gastrointestinal (GI) cancer. Methods We performed a retrospective cross-sectional analysis of the National Inpatient Sample (2018–2023). Adult hospitalizations with active GI cancer were stratified by CDI status. Survey-weighted multivariable regression identified factors associated with CDI and its associations with in-hospital mortality, mechanical ventilation, vasopressor use, renal replacement therapy (RRT), length of stay (LOS), and hospital charges. Results Among 3,572,119 weighted GI cancer hospitalizations, 48,900 (1.37%; 95% CI, 1.34–1.40) involved CDI. Prevalence declined from 1.63% in 2018 to 1.22% in 2023. Inflammatory bowel disease was most strongly associated with CDI (adjusted odds ratio [aOR], 2.47; 95% CI, 2.15–2.85), followed by chronic kidney disease (aOR, 1.61; 95% CI, 1.52–1.71) and solid organ transplantation (aOR, 1.51; 95% CI, 1.15–1.98). Anal cancer had the highest CDI prevalence (2.32%). CDI was associated with higher in-hospital mortality (aOR, 1.34; 95% CI, 1.23–1.46), mechanical ventilation (aOR, 1.87; 95% CI, 1.71–2.05), vasopressor use (aOR, 1.84; 95% CI, 1.61–2.10), and RRT (aOR, 2.27; 95% CI, 2.01–2.56). CDI was associated with 65% longer LOS (LOS ratio, 1.65; 95% CI, 1.61–1.69) and 40% higher charges (charge ratio, 1.40; 95% CI, 1.35–1.45). Conclusion CDI occurred in approximately 1 in 73 GI cancer hospitalizations and was associated with higher mortality, organ-support requirements, and healthcare utilization, supporting targeted prevention and early recognition strategies among hospitalized patients with GI cancer.