In the Journals

CDI incidence nearly doubled from 2001 to 2010

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October 13, 2014

The incidence of Clostridium difficile infections in the United States nearly doubled from 2001 to 2010, according to data published in the American Journal of Infection Control.

“Our study found that peak CDI incidence occurred in 2008, with a slight decline through 2010,” Kelly Reveles, PharmD, PhD, assistant professor at The University of Texas College of Pharmacy, said in a press release. “The leveling off of CDI incidence toward the end of our study period may be the result of increased antibiotic stewardship programs and improved infection control measures, such as use of contact precautions, cleaning and disinfection of equipment and the environment, and hand hygiene.”

Kelly Daniels 

Kelly Reveles

Reveles and colleagues conducted a retrospective analysis using data from the US National Hospital Discharge Surveys. They identified adult patients discharged from the hospital with an ICD-9-CM code for CDI to determine the incidence rates.

From 2001 to 2010, there were 2.2 million adult discharges for CDI. Among these patients, 33% had a principal CDI diagnosis and 67% were secondary CDI diagnoses. In 2001, the incidence of CDI was 4.5 CDI discharges per 1,000 total adult discharges, which nearly doubled to 8.2 CDI discharges per 1,000 total adult discharges in 2010. The lowest CDI incidence rate during the study period was in 2001, and incidence peaked in 2008: 8.6 CDI discharges per 1,000 total adult discharges.

The overall in-hospital mortality rate throughout the study was 7.1%. Mortality increased significantly from 6.6% in 2001 to 7.2% in 2010. Patients with secondary CDI had a significantly higher mortality than patients with principal CDI: 8.8% vs. 3.6%. There was a 2.5% increase in mortality during the study period among patients with secondary CDI, but a decline among patients with principal CDI.

Patients with CDI had a median length-of-stay of 8 days, and this median stay was stable during the study period. The median length-of-stay was 5 days for patients with principal CDI and 9 days for patients with secondary CDI. More patients with a secondary CDI diagnosis were hospitalized for 7 days or more compared with patients with a principal CDI diagnosis: 60.8% vs. 30.5%.

“Several factors may have contributed to the rise in CDI incidence in recent years,” Reveles said. “Antibiotic exposure remains the most important risk factor for CDI.”

According to Jennie Mayfield, BSN, MPH, CIC, president of the Association for Professionals in Infection Control and Epidemiology, it is estimated that up to half of antibiotic use in humans is unnecessary.

“To make headway against CDI, hospitals and health facilities need to get serious about antibiotic stewardship,” Mayfield said in the press release. “With bugs like C. difficile, it takes everyone asking ‘are these antibiotics really necessary?’ to help curb inappropriate use and protect patients.”

Disclosure: Reveles and Mayfield report no relevant financial disclosures.

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