Burden of C. Diff Infections Decreasing in the US

Alice Y. Guh, MPH

New data shows positive trends regarding Clostridium difficile (C. diff) infections and hospitalization within the last 10 years.

A team, led by Alice Y. Guh, MPH, identified cases of C. diff infections in stool specimens positive for C. diff in an individual at least 1 years old with no positive test in the previous 8 weeks in 10 US sites.

In the Emerging Infections Program, the investigators used case and census sampling weights to estimate the national burden of infections, first recurrences, hospitalizations, and in-hospital deaths between 2011-2017.

The team defined healthcare associated infections as those with onset in a healthcare facility or associated with recent admission to a healthcare facility. All other infections were classified as community-associated infections.

For trend analyses, the investigators used weighted random-intercept models with negative binomial distribution and logistic-regression models that allowed them to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types.

Overall, they identified 15,461 cases in 2011—10,177 healthcare-associated cases and 5284 community-associated cases. In 2017, they identified 15,512 cases—7973 healthcare-associated cases and 7539 community-associated cases.

The estimated national burden of infections was 476,400 (95% CI, 419,900-532,900) in 2011 and 462,100 cases (95% CI, 428,600-495,600) in 2017.

After accounting for NAAT use, the adjusted estimate of the total burden of C. diff infection decreased by 24% from 2011 through 2017 (95% CI, 6-36).

The adjusted estimate of the national burden of healthcare-associated cases decreased by 36% (95% CI, 24-54), while the adjusted estimate of the national burden of community-associated infections was unchanged.

For hospitalizations, the adjusted estimate of the burden decreased by 24% (95% CI, 0-48), while the adjusted estimates of the burden of first recurrences and in-hospital deaths did not significantly change.

In research presented as a poster at the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019) in San Antonio, Texas, a team of investigators compared the outcomes of C. diff infections on in-hospital mortality and resource utilization among adult hospitalized patients with ulcerative colitis and Crohn’s disease without a C. diff infection in the US.

A total of 514,889 patients hospitalized with ulcerative colitis were included in the analysis. Of those, 4.81% (24,783) of discharges were related to C. diff infections while out of 878,896 Crohn’s disease hospitalizations, 1.49% (13,120) were related to C. diff infections.

“Our study results provide important insight on the effect of [C. diff infections] on the outcome in patients with [inflammatory bowel disease],” the authors wrote. “Surprisingly, we found that among US adults with [ulcerative colitis] and [Crohn’s disease]-related hospitalizations, [C. diff infections] is associated with significantly subgrouped in-hospital mortality and healthcare utilization only in patients with [ulcerative colitis], and [C. diff infections] infection did not appear to affect the outcomes in the CD-related hospitalizations.”

Investigators have tried to prevent C. diff infections from expanding across the healthcare spectrum in the US, but it is unclear whether these efforts have been effective.

However, initial looks at the data show infections and hospitalizations continue to decrease.

“The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care—associated infections,” the authors wrote.

The study, “Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes,” was published online in The New England Journal of Medicine.