C. difficile Mortality Down Across Past Decade

The past decade of Clostridium difficile (C. difficile) treatment has brought increased incidence and hospital charges, but decreased mortality, according to a new review.

Researchers from the Boston University School of Medicine used the Nationwide Inpatient Sample database from 2005 to 2014 in order to assess changes in incidence, mortality, and hospital charges for C. difficile patients. Specifically, researchers examined risk factors within hospital settings. The database covers about one-fifth of the not-federal acute care hospitals in the US.

The study authors wrote that published data suggests a plateau or even a decline in C. difficile cases among hospitalized patients post-2009. However, the number of cases still remains high, they said.

The database was able to provide patient and infection information such as age, sex, ethnicity, source of admission (such as from community, other acute care hospitals, or long-term care facilities), discharge outcome (either death or survival), length of hospital stay, and total hospital charges incurred by patients. All in all, there were 3,337,910 cases of C. difficile related hospitalizations, or about 1% of the total of more than 300 million hospitalizations.

The investigators learned that the overall rate of mortality among the C. difficile hospitalizations was 8.5%, though the rate decreased significantly across the study period. In 2005, the mortality rate was 9.7%, but it fell to 6.8% by 2014, the researchers wrote.

“Our findings are not surprising because everybody knows about the increasing C. difficile incidence in hospitals; but it's very helpful because it updates the C. difficile infection data in acute care hospitals,” study author Ruihong Luo, MD, ‎Infectious Disease Fellow, Boston Medical Center, told MD Magazine. “We found the C. difficile related mortality decreased, but the cost increased due to the increased incidence. I think most physicians may not be aware of this. The early diagnosis and effective treatment of C. difficile over last years have improved the patients' mortality; however, the incidence is still high in spite of the great efforts on C. difficile control in recent years. I think this is one of the interesting findings in our study.”

The patients who were admitted coming from long-term care facilities were at an increased risk for mortality of about 40%, compared to those admitted from communities.

Total cost of acquiring C. difficile increased from $20.1 billion in 2005 to $31.4 billion in 2014, according to the researchers. The rate increased about 2% annually. An individual patient may have paid $41,974 per hospitalization in 2005 — and that number rose to $46,663 by 2009. However, the cost per hospitalization then decreased to $45,725 by 2010 then decreased further to $41,875 by 2014, the all-time low throughout the study period.

“In addition to the known risk factors like old age, prolonged hospital stay and comorbidities, we found the patients admitted from long-term care facilities were at increased risks for C. difficile and C. difficile associated mortality,” Luo continued. “This has been rarely reported before.”

The difference between management and prevention methods in long term care facilities and acute care hospitals are vast, Dr. Luo added. In the study’s conclusion, the authors detail antibiotic stewardship programs, which may not change C. difficile infection rates. Long term care facility environments also pose hazards such as close residence, shared quarters, shared toilet facilities, and limited availability to isolate infected residents, they wrote.

The paper, titled “Ten-year review of Clostridium difficile infection in acute care hospitals in the USA, 2005—2014,” was published in The Journal of Hospital Infection.

Related Coverage

Considerations in Administration of Alvimopan

Antibiotics Still Major Risk Factor for C. difficile

Procalcitonin Indicates Difference Between Ulcerative Colitis Flare, C. difficile