Clinical Acuity and Total Hospitalization Burden in Liver Transplant Recipients with Clostridioides difficile Infection: A Single-Center Cohort Study

Background: Clostridioides difficile infection (CDI) in liver transplant (LT) recipients often occurs during complex postoperative care. We compared clinical characteristics and total hospital length of stay (LOS) between LT-CDI and non-LT CDI records. Materials and Methods: We analyzed 562 CDI-associated hospital records from 2014 to 2024 (35 LT-CDI; 527 non-LT CDI). The primary endpoint was total hospital LOS; LOS > 30 days was the main secondary endpoint, and >60 and >90 days were post hoc exploratory thresholds for very prolonged stays. LOS was available in 35 LT-CDI and 521 non-LT records. Results: Median LOS was 59 versus 20 days. The crude median difference was 39.0 days (95% CI, 7.0 to 64.0), and the care/antimicrobial-adjusted difference was 28.5 days (95% CI, 0.5 to 50.3). Median LT-to-CDI time was 13 days [IQR, 7 to 36; n = 34]; in 25/35 records (71.4%), infection occurred within 30 days. The adjusted RR for LOS > 30 days was 1.15 (95% CI, 0.85 to 1.55); exploratory RRs were 2.33 (95% CI, 1.45 to 3.73) for >60 days and 2.28 (95% CI, 1.11 to 4.67) for >90 days. Conclusions: LT-CDI records had longer total LOS, clustered early after transplantation, and had a clinically complex course. These findings provide a same-center benchmark for overall hospitalization burden among CDI records by transplant status; estimating CDI-attributable LOS would require an LT group without CDI.