Current Trends of Clostridioides difficile infections (CDI) in the United States: Results from the National Inpatient Sample Database
AffiliationThe University of Arizona College of Medicine - Phoenix
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground Clostridioides difficile infection (CDI) is a cause of significant hospital morbidity and mortality in the United States. Objective Our aim was to analyze the current trends of CDI burden using the National Inpatient Sample (NIS) database, which tracks all hospital discharges in the United States. Methods Using the NIS, all adult discharges (age ≥ 18 years) between 2012 and 2017 were evaluated. Discharges with CDI were identified based on the appropriate ICD9 (00845) and ICD10 (A047, A0471, A0472) codes. All data was analyzed after applying recommended weights using Stata Statistical Software: Release 16. (College Station, TX) and pandas statistical package in Python. Main Measures The overall CDI trends, including incidence, mortality, age, and length of stay were analyzed. The incidence and mortality rates were also analyzed with respect to race, sex, comorbidity (diabetes, hypertension, hyperlipidemia), and hospital location, size, and ownership. Key Results Records representing 181,132,460 adult discharges in the United States over 6 years (2012 – 2017) were included in the analysis; of these, 2,088,825 (1.15%) discharges had CDI. Overall incidence increased until peaking in 2015 at 1.21%, before declining to 1.06% in 2017. Despite the fluctuation in incidence rate, the mortality rate exhibited a steady decrease from 7.32% in 2012 to 6.25% in 2017. Also, the average length of stay decreased from 10.6 days to 9.9 days, along with average age of CDI patients dropping from 67.9 years to 66.2 years. Incidence and mortality rates were consistently higher in males compared to females. Incidence was typically higher in White Americans; however, Asians/Pacific Islanders regularly demonstrated the highest mortality rates during the study period. Finally, incidence and mortality rates were highest in large-bedded, urban teaching hospitals. Conclusion Improvement in overall mortality rate (Δ -1.07%) outpaced improvement in the incidence rate (Δ -0.09%), which may be indicative of improved diagnosis and management of CDI. Specifically, the adoption of oral vancomycin and fidaxomicin as standard treatments may be a key reason for our findings. However, primary prevention efforts are still struggling to effectively control the spread of CDI, especially in large-bedded, urban teaching hospitals – this may be due in part to a higher acuity patient population. Despite limitations, these findings suggest a lessening of overall burden of CDI in the United States.