Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003

Abstract

US hospital discharges for which Clostridium difficile-associated disease (CDAD) was listed as any diagnosis doubled from 82,000 (95% confidence interval [CI] 71,000-94,000) or 31/100,000 population in 1996 to 178,000 (95% CI 151,000-205,000) or 61/100,000 in 2003; this increase was significant between 2000 and 2003 (slope of linear trend 9.48; 95% CI 6.16-12.80, p = 0.01). The overall rate during this period was severalfold higher in persons >65 years of age (228/100,000) than in the age group with the next highest rate, 45-64 years (40/100,000; p < or = 0.001). CDAD appears to be increasing rapidly in the United States and is disproportionately affecting older persons. Clinicians should be aware of the increasing risk for CDAD and make efforts to control transmission of C. difficile and prevent disease.

Figure 1

National estimates of US short-stay hospital discharges with Clostridium difficile listed as primary or as any diagnosis. Isobars represent 95% confidence intervals.

Figure 2

Rates of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by age. Isobars represent 95% confidence intervals. Because of low rates and the resulting uncertainty of yearly rate estimates, data for patients <15 years of age are not included.

Figure 3

Rates of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by region. Northeast (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Pennsylvania), Midwest (Indiana, Illinois, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota), South (Delaware, Washington DC, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma, Texas), and West (Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, Wyoming, Alaska, California, Oregon, Washington, Hawaii) regions as defined by US Census Bureau.

Figure 4

Proportion of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by hospital size (number of beds).