Abstract
BackgroundPrior studies have demonstrated an increase in Clostridium difficile infection (CDI) incidence in the United States (U.S.) in recent years, but trends among different age groups have not been evaluated. This study describes national CDI incidence by age group over a 10-year period and mortality and hospital length of stay (LOS) among patients with CDI.MethodsThis was a retrospective analysis of the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients with an ICD-9-CM discharge diagnosis code for CDI (008.45) were stratified by age: <18 years (pediatrics), 18–64 years (adults), and ≥65 years (elderly adults). Data weights were used to derive national estimates. CDI incidence was calculated as CDI discharges/1000 total discharges. Mortality and LOS were compared between age groups using chi-square or Wilcoxon rank sum tests.ResultsThese data represent 2.3 million hospital discharges for CDI over the study period. CDI incidence was highest among elderly adults (11.6 CDI discharges/1000 total discharges), followed by adults (3.5 CDI discharges/1000 total discharges) and pediatrics (1.2 CDI discharges/1000 total discharges). The elderly also had higher rates of mortality (8.8%) compared to adults (3.1%) and pediatrics (1.4%) (p < 0.0001). In addition, median hospital LOS was highest in the elderly (8 days) compared to adults (7 days) and pediatrics (6 days) (p < 0.0001).ConclusionsCDI incidence among patients hospitalized in U.S. hospitals differed based on age group between 2001 and 2010. CDI incidence, mortality, and hospital LOS were highest in the elderly adult population.
Highlights
Prior studies have demonstrated an increase in Clostridium difficile infection (CDI) incidence in the United States (U.S.) in recent years, but trends among different age groups have not been evaluated
Elderly adult, and pediatric patients with CDI significantly differed with respect to patient sex, race, hospital size and ownership, principal payment source, and admission type and source (p < 0.0001 for all) (Table 1)
The primary admission source was through the emergency room for adults (60.3%) and elderly adults (59.8%); ; pediatric patients were more likely to be admitted by referral (39.2%)
Summary
Prior studies have demonstrated an increase in Clostridium difficile infection (CDI) incidence in the United States (U.S.) in recent years, but trends among different age groups have not been evaluated. Prior studies have affirmed that CDI disproportionately affects the elderly, likely due to immunosuppression from advanced age or chronic comorbidities, more health care exposures, and Pechal et al BMC Infectious Diseases (2016) 16:682 greater antibiotic use [10, 11]. It is unknown if incidence trends differ among age groups [3, 12]. Trends in CDI health outcomes have not been explored by age group
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