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Volume 14
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Article

The Impact of Obesity on Clostridioides difficile Infection Outcomes: A Retrospective Cohort Study

by
Alaa Atamna
1,2,*,
Manar Khalaila
2,
Tanya Babich
2,3,
Anan Zriek
1,
Haim Ben Zvi
2,4,
Gida Ayada
5,
Avishay Elis
2,5,
Jihad Bishara
1,2 and
Amir Nutman
1,6
1
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah-Tikva 49100, Israel
2
Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel
3
Clinical Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel
4
Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel
5
Internal Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel
6
Hospital Management, Wolfson Medical Center, Holon 58100, Israel
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(15), 5459; https://doi.org/10.3390/jcm14155459 (registering DOI)
Submission received: 2 July 2025 / Revised: 26 July 2025 / Accepted: 1 August 2025 / Published: 3 August 2025
(This article belongs to the Special Issue Hospital-Acquired Infections: Evolving Threats and Epidemiological Insights)
Versions Notes

Abstract

Background: Studies have demonstrated a positive correlation between high body mass index (BMI) and an increased risk of Clostridioides difficile infection (CDI), independent of antibiotic usage or healthcare exposures. Aim: To compare the outcomes of obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) hospitalized patients with CDI. Methods: This retrospective cohort study included patients with CDI hospitalized in Beilinson hospital between January 2013 and January 2020. The primary outcome was 90-day all-cause mortality. Secondary outcomes included 30-day mortality, colectomy, intensive care unit (ICU) admission and length of hospital stay (LOS). Multivariate analysis was performed to identify the risk factors independently associated with 90-day mortality. Results: The study included 889 patients: 131 (15%) obese and 758 (85%) non-obese. The obese group was younger (median age 65 years vs. 73 years (p < 0.01)) and with a higher rate of diabetes mellitus (57/131 (44%) vs. 180/758 (24%) (p < 0.01)). The 90-day mortality was lower in the obese group: 19/131 (15%) vs. 170/752 (23%) (p = 0.04). The 30-day mortality was 8/131 (6%) vs. 96/757 (13%) (p = 0.03). ICU admission was 9/131 (7%) vs. 23/758 (3%) (p = 0.03), and median LOS was 19 vs. 12 days (p < 0.01) in obese and non-obese groups, respectively. In the multivariable analysis, after adjustment for age, Charlson’s comorbidity index ≥3, assistance in activities of daily living, treatment with proton pump inhibitors and severity of illness, obesity was not a significant risk factor for 90-day mortality (OR = 0.65, 95% CI: 0.38–1.01; p = 0.1). Conclusions: In this study, obesity was not significantly associated with 90-day mortality after adjustment for other risk factors; however, ICU admission was higher and LOS longer in this group.
Keywords: Clostridioides difficile infection (CDI); obesity; body mass index (BMI); mortality; outcomes; survival paradox Clostridioides difficile infection (CDI); obesity; body mass index (BMI); mortality; outcomes; survival paradox

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MDPI and ACS Style

Atamna, A.; Khalaila, M.; Babich, T.; Zriek, A.; Zvi, H.B.; Ayada, G.; Elis, A.; Bishara, J.; Nutman, A. The Impact of Obesity on Clostridioides difficile Infection Outcomes: A Retrospective Cohort Study. J. Clin. Med. 2025, 14, 5459. https://doi.org/10.3390/jcm14155459

AMA Style

Atamna A, Khalaila M, Babich T, Zriek A, Zvi HB, Ayada G, Elis A, Bishara J, Nutman A. The Impact of Obesity on Clostridioides difficile Infection Outcomes: A Retrospective Cohort Study. Journal of Clinical Medicine. 2025; 14(15):5459. https://doi.org/10.3390/jcm14155459

Chicago/Turabian Style

Atamna, Alaa, Manar Khalaila, Tanya Babich, Anan Zriek, Haim Ben Zvi, Gida Ayada, Avishay Elis, Jihad Bishara, and Amir Nutman. 2025. "The Impact of Obesity on Clostridioides difficile Infection Outcomes: A Retrospective Cohort Study" Journal of Clinical Medicine 14, no. 15: 5459. https://doi.org/10.3390/jcm14155459

APA Style

Atamna, A., Khalaila, M., Babich, T., Zriek, A., Zvi, H. B., Ayada, G., Elis, A., Bishara, J., & Nutman, A. (2025). The Impact of Obesity on Clostridioides difficile Infection Outcomes: A Retrospective Cohort Study. Journal of Clinical Medicine, 14(15), 5459. https://doi.org/10.3390/jcm14155459

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