Luo R, et al. - In this study, researchers aim to determine the change in incidence, mortality and hospital charges for Clostridium difficile infection (CDI) patients in acute care hospitals for the years 2005 to 2014, and to investigate the risk factors associated with hospital-onset CDI (HOCDI) and CDI-related mortality. During the 10 year study period, findings revealed an increased CDI incidence and hospital charges, but a decreased mortality. Patients who were transferred from long-term care facilities (LTCFs) were found to be at higher risk for HOCDI compared with those admitted from the community.

Methods

• A retrospective cohort study using data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was performed from 2005 to 2014.
• Researchers used the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code to identify patients aged ≥ 18 years with a discharge diagnosis of CDI (008.45).
• For this analysis, 4% of HOCDI patients were randomly selected.
• A control group of patients without CDI was selected by performing 1:1 matching with cases of HOCDI by age, sex and calendar year of hospitalization.
• They extracted the variables of demographics (age, sex and ethnicity), source of admission (from community, other acute care hospitals or long-term care facilities), discharge outcome (death or survival), length of hospital stay (LOS), and total hospital charges.
• For this study, the outcomes of interest included the trends for CDI incidence, mortality and hospital charges for each year of the study period and overall, assessed by Poisson regression.
• Using Pearson X² test, the comparison between HOCDI and the control group was analyzed for categorical variables and student’s t test for continuous variables.

Results

• 3,337,910 CDI-related hospitalizations were identified out of a total of 318,703,355 hospitalizations (1.05%).
• Findings revealed that the 10-year incidence of non-HOCDI and HOCDI was 0.42% and 0.63%, respectively.
• The general CDI incidence rose at an average annual rate of 3.3% (95% CI 2.7% - 3.8%) (P<0.001), while the average annual incidence of HOCDI and non-HOCDI rose 1.4% (0.9% - 1.8%) and 2.0% (1.6% - 2.4%), respectively (P<0.001) during the study period.
• Researchers identified 133,278 hospitalizations in each of the HOCDI and the control groups.
• In this study, the average age of the patients was 69.1±16.8 years; 42.1% were male.
• The HOCDI group indicated longer LOS (median 7 vs. 3 days, p<0.001), higher CCI (scores ≥ 3, 32.9% vs. 20%, p<0.001) and were more often admitted from long-term care facilities (LTCFs) than from the community (6.5% vs. 3.0%, p<0.001) compared with the control group.
• A multivariate analysis suggested that after adjusting for demographics, LOS and CCI, patients transferred from LTCFs had twice the risk of HOCDI than those admitted from the community (OR=2.02, 95% CI 1.83-2.23).