Abstract
Background Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States. This study aimed to examine the incidence of CDI and evaluate mortality and economic burden of CDI in an elderly population who reside in nursing homes (NHs).MethodsThis was a population-based retrospective cohort study focusing on US NHs by linking Medicare 5% sample, Medicaid, Minimum Data Set (MDS) (2008–10). NH residents aged ≥65 years with continuous enrollment in Medicare and/or Medicaid Fee-for-Service plan for ≥12 months and ≥2 quarterly MDS assessments were eligible for the study. The incidence rate was calculated as the number of CDI episodes by 100,000 person-years. A 1:4 propensity score matched sample of cohorts with and without CDI was generated to assess mortality and health care costs following the first CDI.ResultsAmong 32,807 NH residents, 941 residents had ≥1 episode of CDI in 2009, with an incidence of 3359.9 per 100,000 person-years. About 30% CDI episodes occurred in the hospital setting. NH residents with CDI (vs without CDI) were more likely to have congestive heart failure, renal disease, cerebrovascular disease, hospitalizations, and outpatient antibiotic use. During the follow-up period, the 30-day (14.7% vs 4.3%, P < 0.001), 60-day (22.7% vs 7.5%, P < 0.001), 6-month (36.3% vs 18.3%, P < 0.001), and 1-year mortality rates (48.2% vs 31.1%, P < 0.001) were significantly higher among the CDI residents vs non-CDI residents. Total health care costs within 2 months following the first CDI episode were also significantly higher for CDI residents ($28,621 vs $13,644, P < 0.001).ConclusionsCDI presents a serious public health issue in NHs. Mortality, health care utilization, and associated costs were significant following incident CDI episodes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0367-2) contains supplementary material, which is available to authorized users.
Highlights
Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States
Clostridium difficile infection (CDI) incidence rates We identified 1,051 incident episodes of CDI among 941 residents with ≥1 CDI episode in a cohort of 32,807 residents who met the eligibility criteria
The majority of CDI episodes occurred in a nursing home (71.7%), and 28.3% occurred in an inpatient hospital setting
Summary
Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States. Clostridium difficile (C. difficile) infection (CDI) is the leading cause of nosocomial diarrhea in the United States and has surpassed the infection rate of other health care-associated infections (HAI) such as methicillin-resistant Staphylococcus aureus [1, 2]. C. difficile was responsible for almost a halfmillion infections and approximately 28,000 deaths in. The emergence of the epidemic BI/NAP1/027 strain has been associated with the increased incidence, severity, and mortality of CDI [5]. The increasing incidence of CDI imposes a large financial burden on the health care system [6]. In 2008, the excess health care costs for CDI in acute care facilities alone were approximately $4.8 billion [7]
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