Study Finds Increased CDI Incidence, Mortality Rates in Urban Teaching Hospitals

In a new study presented at the annual American College of Gastroenterology (ACG) 2020 conference, incidence and mortality rates of clostridium difficile infection (CDI) were shown to be higher in urban teaching hospitals when compared with urban non-teaching and rural hospitals.

Furthermore, the study found that incidence and mortality rates were higher in large bedded hospitals, while only incidence rates were higher in private, non-profit hospitals.

These findings were determined from an analysis of the National Inpatient Sample (NIS) database.

A team led by Jiali Ling, MS, of the University of Arizona College of Medicine, Phoenix, used the database to assess the effects of hospital parameters—such as location, teaching status, bed size, and ownership—on CDI incidence and outcomes.

To do this, they evaluated a total of 181,132,460 records between the years 2012-2017. Thus, a total of 2,089,130 admissions had CDI.

They noted that of these admissions, 1,905,860 (91.24%) were attributed to urban hospitals, and 182,965 (8.76%) were attributed to rural hospitals.

Urban teaching hospitals had 1,282,145 (67.27%) CDI admissions—versus 623,715 (32.73%) in urban non-teaching hospitals.

The investigators also reported that over the 6 years of analysis, the mortality rate in urban teaching hospitals was 68.91% in comparison with 31.09% in urban non-teaching hospitals. However, they did note that mortality rates in both rural and urban hospitals saw a decline over the same time period.

Hospitals with large beds saw higher CDI incidence, trending from 1.19%-1.10% from 2012-2017. On the other hand, small bedded hospitals had the lowest incidence of CDI, trending from 1.07%-1%.

Further, the authors noted that mortality rates were also higher in large bedded hospitals. There was a significant improvement in mortality seen in medium bedded hospitals after 2013.

And finally, they found that by the end of the study period, private non-profit hospitals had a higher CDI incidence (1.10%) than government non-federal (1.04%) and private investor owned hospitals (0.87%).

For government non-federal hospitals, there was a peak in mortality rates in 2013 (7.74), and there was a noted increasing trend in 2016, but the investigators did not consider this to be statistically significant.

Ling and colleagues sought to understand the trends and patterns they found in their data.

“Our results could be explained by the large number of complex, often tertiary referral, cases seen at teaching hospitals and the larger census encountered in large hospital systems, compared to smaller, privatized, non-teaching hospitals,” they wrote.

They acknowledged that further studies are necessary to evaluate other confounding variables.

The study, "Incidence and Mortality Rates in Clostridium difficile Infections in the United States Based on Hospital Facilities: Results From National Inpatient Sample Database 2012-2017,” was published online by ACG.