A 10-year Review of Clostridium difficile Infection in Acute Care Hospitals in the United States

BACKGROUND: Many strategies reported to decrease CDI occurrence have been implemented in acute care hospitals in recent years. We assessed the change in incidence, mortality and hospital charges of CDI patients in acute care hospitals during 2005–2014. We also investigated risk factors for hospital-onset CDI (HOCDI) and predictive factors for mortality of CDI patients. METHODS: Using the Nationwide Inpatient Sample database, we identified adult patients (¡Ý 18 years) with CDI by ICD-9-CM codes. The trends of CDI incidence, mortality and hospital charges were evaluated by Poisson regression. The risk for HOCDI and factors to predict in-hospital death of CDI patients were analyzed by logistic regression. RESULTS: 3,337,910 cases of CDI were identified out of a total of 318,703,355 hospitalizations (1.05%). Incidences of non-HOCDI and HOCDI were 0.42% and 0.63% respectively. In the 10-year study period, CDI incidence increased with an annual rate of 3.3% (P < 0.001). The annual incidences of HOCDI and non-HOCDI increased with a rate of 1.4% and 2.0% respectively (P < 0.001). After adjusting for demographics, length of hospital stay and Charlson index, transfer from long-term health facilities (OR=2.02, 95% CI 1.83–2.23) and admission to a teaching hospital (OR=1.10, 95% CI 1.05–1.15) were independent risk factors for HOCDI. The in-hospital mortality of CDI associated hospitalization decreased from 9.7% in 2005 to 6.8% in 2014 (P < 0.001). Transfer from long-term health facilities significantly predicted the risk for in-hospital death in CDI patients (OR= 1.34, 95% CI 1.32–1.36). The sum charge of all CDI hospitalizations increased with an annual rate of 2.0% (P < 0.001). The median charge per CDI hospitalization increased during 2005–2009 (P < 0.001), and then decreased during 2010–2014 (P < 0.001). CONCLUSION: During 2005–2014, the mortality in CDI hospitalized patients decreased, but CDI incidence in acute care hospitals increased, resulting in increased total CDI associated hospital charges. Patients transferred from long-term healthcare facilities increased the risk for HOCDI and CDI associated in-hospital mortality. They should be considered as high-risk patients for CDI surveillance when developing mitigation strategies. DISCLOSURES: All authors: No reported disclosures.