1389. Trends in C. difficile: Incidence and Costs - The Nationwide Inpatient Sample
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: C. difficileinfection (CDI) is the commonest cause of nosocomial diarrhea and has been associated with increasing incidence, severity, and cost. There is a scarcity of studies evaluating trends in proportion of patients with primary CDI among all inpatients with CDI. The purpose of this study was to assess these trends, and the trends in costs in inpatients with primary diagnosis of CDI using the Nationwide Inpatient Sample (NIS).

Methods: The NIS contains data on hospital inpatient stays representing 85 to 90 percent of the U.S. population and includes all discharges from an approximate 20 percent stratified sample of U.S. community hospitals containing data from approximately 8 million hospital stays each year. NIS data was obtained from http://www.hcup-us.ahrq.gov/nisoverview.jspand data analysis was performed using JMP version 9.0.1 to assess for trends in proportion of primary CDI, length of stay (LOS), mortality and cost from 1993 to 2010.

Results: For the years 1993 to 2010, there were an estimated 666.7 million hospital dismissals, with the overall rate of CDI 0.55%, with 0.15% being primary CDI diagnosis. For the years 1993 - 2010, the rate of all CDI increased significantly from 0.25% - 0.89%, p<0.0001 and the rate of primary CDI diagnosis varied from 0.07% - 0.28%, p<0.0001. The proportion of patients with primary CDI diagnosis of those with CDI varied from 19.7 - 32.8%, p<0.0001.

From 1993 - 2010, the mean LOS declined from 5.7 to 4.7 days for all admissions, and from 8.6 to 6.7 days for CDI as primary diagnosis, but the cost of all inpatients increased from a median of $5,180 to $17,549 compared to a rise from $6,482 to $21,464 for primary CDI diagnosis. The overall in-hospital mortality decreased from 2.7 (1993) to 1.9% (2010), p<0.001, but patients with primary CDI infection varied from 2.6% - 4.1% with a statistically significant increasing trend, p=0.01.

Conclusion:   From 1993-2010, the proportion of patients with primary CDI increased, LOS decreased, but both cost and mortality in primary CDI patients increased, despite a drop in overall in hospital mortality

Sahil Khanna, MBBS, MS, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN and Darrell Pardi, MD, MS, Division Of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN


S. Khanna, None

D. Pardi, None

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