Epidemiology and Predictors of 90-Day Mortality in Patients with Clostridioides difficile Infection: A Retrospective Single-Center Study from Galati, Romania

Background: Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality, but data on 90-day mortality after hospitalization from Romania remain limited. This study characterized hospitalized patients with CDI at a regional infectious diseases hospital in south-eastern Romania and evaluated factors associated with 90-day all-cause mortality. Methods: We conducted a retrospective observational study of adults with laboratory-confirmed CDI admitted to Infectious Diseases Clinical Department I between 1 January and 31 December 2024. The date of hospital admission for the index CDI episode was defined as time zero for the 90-day follow-up. Clinical, epidemiological, laboratory, and treatment variables were analyzed; ATLAS components were assessed at CDI diagnosis, while urinary-catheter (UC) exposure was analyzed separately because the source records did not reliably establish whether catheter placement preceded or followed CDI diagnosis in every patient. Associations with 90-day all-cause mortality were assessed using multivariable logistic regression. Results: Among 170 patients (median age, 70 years), 55 died within 90 days (32.4%; 95% CI, 25.4–39.9%). Overall, 99/170 patients (58.2%; 95% CI, 50.4–65.7%) had an age-adjusted Charlson Comorbidity Index >5. In the final multivariable model, ATLAS score >4 (adjusted OR [aOR], 3.52; 95% CI, 1.56–7.95; p = 0.002) and indwelling UC exposure (aOR, 2.88; 95% CI, 1.12–7.37; p = 0.028) were associated with 90-day all-cause mortality. The model showed good discrimination (AUC, 0.746; 95% CI, 0.664–0.828). Conclusions: Ninety-day all-cause mortality was substantial in this single-center Romanian cohort. Higher ATLAS score and UC exposure were associated with mortality, but the UC association is exploratory because catheter timing relative to CDI diagnosis was not reliably available. Prospective multicenter external validation is required before these findings are used for clinical risk stratification.