Clostridioides difficile infection in US hospitals: a national inpatient sample study
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ORIGINAL ARTICLE
Clostridioides difficile infection in US hospitals: a national inpatient sample study Daryl Ramai 1 & Khoi Paul Dang-Ho 1 & Chris Lewis 2 & Paul J. Fields 2 & Andrew Ofosu 3 & Mohamed Barakat 3 & Ali Aamar 3 & Emmanuel Ofori 3 & Jonathan Lai 4 & Gandhi Lanke 5 & Amaninder Dhaliwal 6 & Madhavi Reddy 3 & James Gasperino 7 Accepted: 20 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Hypervirulent strains of Clostridioides difficile have altered the landscape of hospital and community outbreaks. We aim to examine and compare spatiotemporal trends, incidence, hospital teaching status, mortality, and cost associated with hospital-acquired Clostridioides difficile infection (HCDI) and community-acquired Clostridioides difficile infection (CCDI). Methods Retrospective cohorts were studied using data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) from 2006 to 2015. Results A total of 76,124 cases of HCDI and 190,641 cases of CCDI were identified within the study period. The incidence of HCDI decreased from 8555 in 2006 to 7191 in 2015. Mortality also decreased during the same period (5.9% in 2006 to 1.4% 2015, p < 0.0001). Conversely, CCDI cases increased from 13,823 in 2006 to 20,637 in 2015. CCDI mortality decreased during the same period (4.3% in 2006 to 1.9% 2015, p < 0.0001). Rural hospital centers experienced the sharpest decline in HCDI mortality compared to urban and urban teaching centers (3.8%, p < 0.0001 vs 2.8%, p < 0.0001 vs 2.1%, p < 0.0001). Multivariate logistic regression indicated that increasing age (p = 0.0001), increasing hospital length of stay (p = 0.0001), and Medicare insurance (p = 0.002) were significant predictors of mortality for CDI mortality. Geospatial mapping of CCDI and HCDI revealed that the Eastern and Southern US experienced the largest incidence of CDI over 10 years. Conclusion The incidence of HCDI has decreased in the past decade while the incidence of CCDI hospitalization is sharply on the rise. While hospital length of stay and mortality has decreased over time, the cost of treating CDI remains high. Keywords Community acquired clostridioides difficile infection (CCDI) . Clostridioides difficile . Health care cost and utilization project (HCUP) . Hospital-aquired clostridioides difficile infection (HCDI) . National inpatient sample (NIS)
Introduction * Daryl Ramai [email protected] 1
Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
2
Windward Islands Research and Education Foundation, St George’s University School of Medicine, Saint George, Grenada
3
Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, NY, USA
4
Department of Pathology, McGill University, Montreal, QC, Canada
5
Department of Internal Medicine, Covenant Medical Center, Lubbock, TX, USA
6
Division of Gastroenterology, University of Nebraska Medical Center, Omaha, NE, USA
7
Division of Critical Care Medicine, The Brooklyn Hospital Center
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