Clostridioides difficile infection in hematologic malignancy patients with and without bone marrow transplantation: A nation-wide cross-sectional study.

Clostridioides difficile infection (CDI) is a frequent and consequential healthcare-associated complication in patients with hematologic malignancies (HMs), particularly in the setting of bone marrow transplant (BMT); however, national data comparing the impact of CDI across HM hospitalizations with and without BMT remain significantly limited. To evaluate associations between CDI and key inpatient outcomes like in-hospital mortality, length of stay (LOS), and total hospital charges, this retrospective cross-sectional analysis was conducted using the Nationwide Inpatient Sample. Multivariable models were fitted using survey-weighted logistic regression for mortality and Poisson regression with a log link for LOS and charges, adjusting for demographic and clinical covariates to calculate adjusted odds ratios and incidence rate ratios. Among an estimated 2.86 million adult HM hospitalizations, most involved neither exposure, while smaller proportions involved BMT only, CDI only, or both. In adjusted analyses, CDI was independently associated with higher odds of in-hospital death and substantially increased LOS and hospital charges. BMT was associated with markedly higher mortality and pronounced increases in LOS and charges. Hospitalizations complicated by concurrent CDI and BMT demonstrated the greatest burden across outcomes, with significantly increased mortality risk and the largest increases in LOS and charges (all p < 0.001). These findings indicate that CDI was associated with worse clinical and economic outcomes in hospitalized HM patients, with the highest risk observed when CDI occurs in post-transplant settings. Targeted prevention, early diagnosis, and prompt treatment of CDI therefore represent high-yield opportunities to reduce inpatient morbidity, mortality, and resource utilization in this vulnerable population.