September 11, 2013
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CDI incidence doubled since 2001

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DENVER — The incidence of Clostridium difficile infections nearly doubled from 2001 to 2010, according to study data presented here at the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy.

Since 2008, the incidence has leveled off, Kelly Daniels, PharmD, of the University of Texas at Austin, said at a press conference, but there has been no decline.

Kelly Daniels, PharmD 

Kelly Daniels

“There have been large studies that have demonstrated an increase of C. difficile in the United States, Europe and Canada in the 1990s and early 2000s, but recent studies are limited,” Daniels said. “Last year, the Agency for Healthcare Research and Quality (AHRQ) published a report documenting the rise of CDIs in the United States. The goal of our research was to supplement the AHRQ report by looking at trends in CDI incidence using another large national database.

Daniels and colleagues conducted a retrospective analysis of data from the CDC’s National Hospital Discharge Survey. They identified patients with an ICD-9-CM code for CDI, and then determined the incidence of cases. They also evaluated mortality and hospital length of stay for patients with CDI.

There were 2.2 million patients with CDI during the study period: 32.5% were primary infections and 67.5% were secondary infections. In 2001, the incidence was 4.5 cases per 1,000 hospitalizations, and in 2010, the incidence was 8.2 cases per 1,000 hospitalizations.

The trend was similar for both primary and secondary cases.

The overall mortality rate was 7.1% for the study period and was higher for patients with secondary CDI: 8.8% vs. 3.3% for patients with primary CDI (RR=1.8; 95% CI, 1.76-1.84). The median length of stay was 8 days and also was higher among patients with secondary infection: 9 days vs. 5 days (RR=13.3; 95% CI, 9.6-18.5).

Daniels said ICD codes do not always mean that there is a laboratory confirmation of CDI, but the incidence may be overestimated because physicians may make a diagnosis based on clinical presentation alone.

“The main take-home message is that physicians need to be aware that CDI is still a significant problem in hospitals,” Daniels told Infectious Disease News. “Being aware of this should encourage physicians to put more effort into prevention by making sure to use contact precautions, practicing good hand hygiene and using antibiotics judiciously. These are all key to preventing CDI and all health care-acquired infections.”

Daniels said this study did not include data from federal hospitals, which are not included in the National Hospital Discharge Survey, but she is currently conducting a study examining CDI incidence at VA Hospitals. She also is interested in studying the incidence of CDI among outpatients and the incidence of community-acquired CDI.

For more information:

Daniels K. #K-327. Presented at: ICAAC 2013; Sept. 10-13; Denver.

Kelly Daniels, PharmD, can be reached at UTHSCSA, Pharmacotherapy Education & Research Center, 7703 Floyd Curl Drive, MC 6220, San Antonio, TX, 78229-3900; email: kdaniels46@utexas.edu.

Disclosure: Daniels reports no relevant financial disclosures.