PURPOSE: C. difficile infection (CDI) is increasing in frequency and severity, with the critically ill and the elderly being particularly vulnerable. In the US, age-adjusted hospitalizations and case fatality from CDI nearly doubled between years 2000 and 2005. We update the data on hospitalizations with CDI in the US through year 2008.
METHODS: We identified, via ICD-9-CM code, all adult CDI-related hospitalizations for 2000-2008 in the National Inpatient Sample data available on the Healthcare Costs and Utilization Project Net website. Discharges were age stratified. We obtained total US hospitalizations by age group from the NIS and censal and intercensal data from the US Census Bureau and calculated age-specific annual CDI hospitalization incidence rates.
RESULTS: The total number of adults discharged with a CDI diagnosis increased 2.5-fold, from 134,361 in 2000 to 340,352 in 2008, equating to 19.2% crude per annum growth. The corresponding age-stratified incidence of hospitalizations with CDI more than doubled for each age group, and overall went from 7.69 to 14.79 per 10,000 population. Normalizing the data to all hospitalizations in the US, the overall incidence of CDI among adults rose from 4.47 in 2000 to 10.16 in 2008 per 1,000 adult hospitalizations. The age-stratified growth mirrored this rise. The proportion of all CDI hospitalizations that represented principal diagnoses rose from 23.4% in 2000 to 32.6% in 2008, and the associated hospital mortality climbed from 3.4% in 2000 to 4.1% in 2008.
CONCLUSIONS: CDI hospitalizations in the US continue to rise. Their growth far outpaces the rate of the general hospitalizations and underlying population shifts. The proportion of hospitalizations that carries CDI as the principal diagnosis has also increased.. Though the hospital mortality when CDI represents the principal diagnosis has increased, this may reflect secular fluctuations in this outcome.
CLINICAL IMPLICATIONS: The increasing population incidence of CDI hospitalizations and the associated case fatality demand increased focus on prevention.
DISCLOSURE: Marya Zilberberg: Grant monies (from industry related sources): ViroPharma, Grant monies (from industry related sources): Optimer, Consultant fee, speaker bureau, advisory committee, etc.: ViroPharma, Consultant fee, speaker bureau, advisory committee, etc.: Optimer
Glenn Tillotson: Employee: ViroPharma, Shareholder: ViroPharma, Employee: Optimer, Shareholder: Optimer
The following authors have nothing to disclose: Marin Kollef, Andrew Shorr
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