Examining Clostridioides difficile Incidence and Clinical Impact Across the US

Clostridioides difficile infection (CDI) results in significant inpatient costs, rehospitalization, and mortality for hospitalized patients, according to a retrospective, longitudinal analysis of a contemporary hospital database.

Glenn S. Tillotson, PhD, FIDSA, FCCP, senior consultant with GST Micro, and colleagues presented this data in a poster at the Making a Difference in Infectious Disease (MAD-ID) 2022 annual meeting, held May 18-21, 2022, in Orlando, Florida, titled “Twelve-Month Inpatient Mortality and Economic Burden of Clostridioides difficile Infections in the US: 2016-2019.”

Pulling numbers from the Premier Healthcare Database, the team included data on more than 100,000 patients (mean age of 66 years) who had been hospitalized with a primary or secondary ICD-10CM discharge diagnosis of CDI. Eligible participants had no CDI-related hospitalizations in the prior year.

Investigators measured outcomes including all-cause inpatient mortality, rehospitalizations, and hospitalization costs.

Throughout 12 months of follow-up after initial index hospitalization, 21% (n = 22,987), 10% (10,395), and 11% (12,096) of patients had either 1, 2, or 3+ all-cause rehospitalizations, respectively. Of those, 45%, 25%, and 18% were related to CDI, respectively, and 11% of patients died.

“During the index CDI hospitalization, 6.4% died, and 6.8%, 5.7%, and 4.2% died for first, second, and third CDI-related rehospitalization,” Tillotson and colleagues reported. “While average index CDI hospitalization cost was $25,691, cumulative CDI-related hospital costs for patients with 1, 2, 3, and 4+ CDI-related rehospitalizations were $43,601, $60,996, $78,356, and $110,618, respectively.”

In a video interview with Contagion®, Tillotson discussed the problem with conventional treatment for CDI.

“Part of the problem with antibiotics is they cause damage to an already disturbed field. I think the important part of managing C diff is to actually restore the damage that’s been done whether it’s by antibiotics or proton pump inhibitors,” he said. “There are different approaches to it. Each has its advantages and disadvantages, but I think the logic of replacing the entire holistic microbiome is a way forward."

There are some promising alternative treatments on the horizon, Tillotson noted, including things like fecal microbiota transplantation.

“I’ve been involved with C diff since 1978, since it was discovered, and I think it’s fascinating that, even now, were learning about the disease and the organism,” he said. “I think, with some of these new techniques and technologies, the future is going to be even more interesting.”