{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:06:10Z","timestamp":1793120770070,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Clostridioides difficile infection (CDI) is the leading cause of colitis and hospital-acquired diarrhea. Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently have infectious exacerbations requiring treatment with antibiotics, which may be predisposing them to CDI. This study examines the prevalence and in-hospital outcomes of CDI in patients with COPD. Methods: Data for hospitalized patients with CDI was extracted from the National Inpatient Sample database for the years 2016 through 2020. Baseline risk factors were identified using the International Classification of Diseases codes. Patients were stratified into two groups: with COPD and without COPD. The primary outcome was in-hospital mortality. The secondary outcomes were septic shock, hypovolemic shock, AKI, cardiac arrest, need for intensive care unit (ICU) level of care and length of stay. Statistical analyses were conducted using SPSS. Results: 290,172 patients were included in this study. Patients with COPD had more comorbidities overall and higher in-hospital mortality rates compared to patients without COPD (7.7% vs. 5.9%, p &lt; 0.001). On multivariate logistic regression analysis, patients with CDI and COPD had higher risk of in-hospital mortality (OR = 1.346, p &lt; 0.001), septic shock (OR = 1.289, p &lt; 0.001), hypovolemic shock (OR = 1.184, p &lt; 0.001), cardiac arrest (OR = 1.362, p &lt; 0.001) and required more ICU level of care. Conclusions: Patients with COPD experience frequent exacerbations, often requiring hospitalizations and broad-spectrum antibiotics, steroids, proton pump inhibitors and antacids. These factors contribute to the higher prevalence of CDI in this patient population. Patients with CDI and COPD are also more likely to require ICU level of care, shedding the light on the significant burden of CDI, long hospital stays and substantial hospital charges. Recognizing mortality outcomes is essential to guide patient-specific therapies and highlights the need for closer monitoring and targeted management of CDI in patients with COPD.<\/jats:p>","DOI":"10.3390\/jcm15114110","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:02:51Z","timestamp":1779793371000},"page":"4110","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Burden and Mortality Outcomes of Clostridioides difficile Infection Among Patients with Chronic Obstructive Pulmonary Disease: Findings from a Nationwide Database"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2346-8733","authenticated-orcid":false,"given":"Chloe","family":"Lahoud","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2337-7516","authenticated-orcid":false,"given":"Daniel","family":"Kalta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"John","family":"Afif","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Morningside\/West, New York, NY 10025, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Aysan","family":"Sattarzadeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1256-5769","authenticated-orcid":false,"given":"Faris","family":"Qaqish","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Tamara","family":"Merhej","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Rabindra","family":"Dhakal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Suzanne","family":"El-Sayegh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"},{"name":"Department of Nephrology, Staten Island University Hospital, Northwell Health, 475 Seaview Avenue, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1056\/NEJMoa1910215","article-title":"Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes","volume":"382","author":"Guh","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1093\/cid\/ciu125","article-title":"NAP1 strain type predicts outcomes from Clostridium difficile infection","volume":"58","author":"See","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1503\/cmaj.110543","article-title":"The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital","volume":"184","author":"Forster","year":"2012","journal-title":"Can. Med. Assoc. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1038\/ajg.2015.48","article-title":"The economic impact of Clostridium difficile infection: A systematic review","volume":"110","author":"Nanwa","year":"2015","journal-title":"Am. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"717","DOI":"10.12788\/jhm.2816","article-title":"National Trends (2007\u20132013) of Clostridium difficile Infection in Patients with Septic Shock: Impact on Outcome","volume":"12","author":"Chatterjee","year":"2017","journal-title":"J. Hosp. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1093\/cid\/ciu419","article-title":"Bartlett: Contributions to the discovery of Clostridium difficile antibiotic-associated diarrhea","volume":"59","author":"Gorbach","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.anaerobe.2017.03.003","article-title":"Factors associated with Clostridium difficile infection: A nested case-control study in a three year prospective cohort","volume":"44","author":"Khanafer","year":"2017","journal-title":"Anaerobe"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s40121-024-00919-0","article-title":"A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States","volume":"13","author":"Eeuwijk","year":"2024","journal-title":"Infect. Dis. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jhin.2012.11.009","article-title":"Incidence and risk factors for hospital-acquired Clostridium difficile infection among inpatients in an orthopaedic tertiary care hospital","volume":"83","author":"Campbell","year":"2013","journal-title":"J. Hosp. Infect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.ajic.2016.03.069","article-title":"Clostridium difficile-associated disease: A primary clinical evaluation of elderly patients in a geriatric hospital","volume":"44","author":"Leibovitz","year":"2016","journal-title":"Am. J. Infect. Control"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e4187","DOI":"10.1097\/MD.0000000000004187","article-title":"Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011: A nationwide study","volume":"95","author":"Ziakas","year":"2016","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"48.e1","DOI":"10.1016\/j.cmi.2016.08.030","article-title":"Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012-2014: Prospective, repeated cross-sectional study","volume":"23","author":"Clements","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.tim.2016.02.001","article-title":"Involvement of Bacteria Other Than Clostridium difficile in Antibiotic-Associated Diarrhoea","volume":"24","author":"Larcombe","year":"2016","journal-title":"Trends Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"601","DOI":"10.2147\/COPD.S498513","article-title":"Causal Associations Between Chronic Obstructive Pulmonary Disease and Common Comorbidities: Evidence from Comprehensive Genetic Methods","volume":"20","author":"Ji","year":"2025","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1007\/s10198-013-0498-8","article-title":"Increased hospital length of stay attributable to Clostridium difficile infection in patients with four co-morbidities: An analysis of hospital episode statistics in four European countries","volume":"14","author":"Eckmann","year":"2013","journal-title":"Eur. J. Health Econ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S2213-2600(15)00241-6","article-title":"Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis","volume":"3","author":"Chen","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1001\/jama.2024.8771","article-title":"Bisoprolol in Patients with Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation: The BICS Randomized Clinical Trial","volume":"332","author":"Devereux","year":"2024","journal-title":"JAMA"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1104","DOI":"10.1093\/infdis\/jiag001","article-title":"Antibiotic and Nonantibiotic Drugs Associated with Clostridioides difficile Infection Risk: A Pharmacopoeia-Wide Case-Cohort Study","volume":"233","author":"Brown","year":"2026","journal-title":"J. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ejim.2018.06.022","article-title":"Clostridium difficile infection in hospitalized patients with COPD in Spain (2001\u20132015)","volume":"57","year":"2018","journal-title":"Eur. J. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1164\/rccm.202407-1320ST","article-title":"A Research Agenda to Improve Outcomes in Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: An Official American Thoracic Society Research Statement","volume":"210","author":"Myers","year":"2024","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Li, X.F., Wan, C.Q., and Mao, Y.M. (2022). Analysis of pathogenesis and drug treatment of chronic obstructive pulmonary disease complicated with cardiovascular disease. Front. Med., 9.","DOI":"10.3389\/fmed.2022.979959"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.14309\/ajg.0000000000001278","article-title":"ACG Clinical Guidelines: Prevention, Diagnosis, and Treatment of Clostridioides difficile Infections","volume":"116","author":"Kelly","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2913","DOI":"10.1007\/s10620-015-3714-9","article-title":"The Risks of Incident and Recurrent Clostridium difficile-Associated Diarrhea in Chronic Kidney Disease and End-Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis","volume":"60","author":"Phatharacharukul","year":"2015","journal-title":"Dig. Dis. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1053\/j.ackd.2019.01.001","article-title":"Clostridioides difficile Infection in Chronic Kidney Disease\/End-Stage Renal Disease","volume":"26","author":"Ramesh","year":"2019","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Du, B., Fu, Y., Han, Y., Sun, Q., Xu, J., Yang, Y., and Rong, R. (2023). The lung-gut crosstalk in respiratory and inflammatory bowel disease. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1218565"},{"key":"ref_26","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2026, January 03). 2025 REPORT Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online: https:\/\/goldcopd.org\/wp-content\/uploads\/2024\/11\/GOLD-2025-Report-v1.0-15Nov2024_WMV.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1038\/ajg.2013.4","article-title":"Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections","volume":"108","author":"Surawicz","year":"2013","journal-title":"Am. J. Gastroenterol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4110\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:11:06Z","timestamp":1788351066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114110"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114110","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}