Neutropenia and the Risk of Clostridioides difficile Infection, Fungemia, and Bacteremia: A Nationwide Inpatient Sample Analysis.

Background This study aimed to examine the association of neutropenia with Clostridioides difficile infection (CDI), fungal bloodstream infection, and bacteremia and to evaluate the unadjusted associations of these infections with in-hospital mortality among neutropenic hospitalizations. Methodology This retrospective cross-sectional study used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2017 to 2020. Logistic regression models were applied to assess the association between neutropenia, infection rates, and the likelihood of in-hospital mortality. Results Patients with neutropenia were 3.69 times more likely to develop CDI (95% confidence interval (CI): 3.11-4.38), 7.08 times more likely to develop fungemia (95% CI: 5.27-9.73), and 5.07 times more likely to develop bacteremia (95% CI: 4.63-5.56). Among neutropenic patients, the odds ratio (OR) for fungemia was 3.21 (95% CI: 2.35-4.30, p < 0.001), whereas the OR for CDI was not statistically significant (p = 0.122). The OR for bacteremia was 0.60 (95% CI: 0.48-0.74, p < 0.001). This unadjusted result should not be seen as protective and is considered hypothesis-generating. Conclusions In this sample, neutropenia was associated with higher odds of all three infections, and fungemia was associated with higher in-hospital mortality. These results should be viewed with caution because the analyses were unweighted and unadjusted, and the database did not include detailed information on clinical severity or treatment.