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C. difficile cases highest in Northeast, springtime
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Rates of infection with Clostridium difficile were highest in the Northeast region of the United States and in the spring during the last 10 years, according to a study published in the American Journal of Infection Control. However, C. difficile mortality was greatest in the Midwest and during winter months.
“The peak incidence in the spring could be attributed to increased utilization of antibiotics in winter months. Prior studies have found a 1- to 2-month lag time between antibiotic exposure and the development of [C. difficile],” Jacqueline R. Argamany, a PharmD candidate at the University of Texas, and colleagues wrote. “Previous studies have shown that infection-specific and overall mortality are highest in the United States during the winter months.”
Antibiotic exposure is the primary risk factor for C. difficile because of the disruption of gastrointestinal microbiota diversity, the researchers wrote. Antibiotic classes with the greatest risk for C. difficile infection are clindamycin, cephalosporins and fluoroquinolones, they added.
Argamany and colleagues retrospectively analyzed the CDC’s National Hospital Discharge Survey and identified 2.3 million cases of C. difficile infection from 2001 to 2010. Study data showed the highest incidence of C. difficile infection in the Northeast (8 discharges/1,000 total discharges), followed by the Midwest (6.4/1,000), South (5/1,000) and the West (4.8/1,000).
Hospital stays, especially those of greater duration, can put patients at greater risk for C. difficile, according to the researchers. In 2010, patients in the Northeast had the longest average length of stay at 5.5 days vs. 4.4 days in the West, which might help explain regional discrepancies, they wrote.
Seasonally, spring had the most cases (6.2 discharges/1,000 total discharges), followed by winter and summer (both 5.9/1,000) and fall (5.6/1,000). Adults and older adults followed overall trends, according to the researchers, whereas the incidence of pediatric C. difficile infection was greatest in winter.
Older adults were at the greatest risk for C. difficile and had the highest mortality rate (8.8%) compared with adults (6.9%) and children (3.1%).
According to the CDC, C. difficile has become the most common cause of health care-associated infections in U.S. hospitals, with up to $4.8 billion annually in excess health care costs for acute care facilities alone. The CDC estimates that C. difficile caused almost half a million infections in 2011 and that 29,000 U.S. patients died within 30 days of initial diagnosis.
“Results of this study may be used to direct resources and implement targeted control measures where and when they are needed most,” the researchers concluded. – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
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