920. Geographic Distribution of Clostridium difficile Infection Burden by Various Counties in Michigan
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • IDSA poster.pdf (491.1 kB)
  • Background:

    Clostridium difficile infection (CDI) is an URGENT level of threat in United States as published by US Government in a stark report entitled “Antibiotic Resistant Threats in the United States, 2013” Yet there is limited information on geographic distribution of CDI in the community. The present study compared the rates of hospital admissions due to CDI, number of ED visits and number of readmissions within 30 days of hospital discharge for all counties of Michigan, USA.


    Using Michigan CMS claims data from 2014, we examined geographic trends in C. difficile discharges and readmissions for all counties in Michigan. We then identified counties with the highest number of discharges and readmissions. In additional analysis, we focused on specific clinic providers to understand the burden of CDI among different clinic locations across Michigan.


    Counties 4, 5 and 7 accounted for a large number of patients with CDI. Patients in these counties also experienced relatively high numbers of 30 day hospital readmissions and emergency department (ED) visits associated with CDI. Analysis of the same data by providers depicted a very similar trend. These high CDI burden NPI providers were located in a tri-county area of counties 4, 5 and 7 in Michigan.


    Total C. difficile discharges

    30 day ED Visits

    (ED Visit Rate %)

    30 Day Hospital Readmissions (Hospital Readmission Rate %)


                        N (%)

    N (%)

    County 1


                      156 (40.52)

    25 (6.49)

    County 2


                      40 (37.38)

                               6 (5.61)

    County 3


                      31 (29.81)

                               7 (6.73)

    County 4


                      230 (30.03)

     47 (6.14)

    County 5


                      371 (36.37)

     41 (4.02)

    County 6


                      67 (39.64)

    7 (4.14 )

    County 7


                      686 (40.38)

     75 (4.41)


    The high CDI burden in concentrated pockets in the community suggests that these county health care providers may be amenable to interventions specifically focused on CDI knowledge, prevention and treatment.

    Babbaljeet Kaur, MD1, Paul Kilgore, MD, MPH2, Abdulbaset Salim, MD, MPH3, Elizabeth Waldman, MPH4, Gloria E. Pizzo, RN/BSN4, Harolyn Baker, MPH5, Jackie Rosenblatt, PhD4, Keith Kaye, MD, MPH, FIDSA, FSHEA6 and Teena Chopra, MD, MPH1, (1)Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI, (2)Pharmacy Practice, Wayne State University, Detroit, MI, (3)Detroit Medical Center/Wayne State University, Detroit, MI, (4)MPRO, Michigan's Quality Improvement Organization, Farmington Hills, MI, (5)Applied Epidemiology and Evaluation, MPRO, Michigan's Quality Improvement Organization, Farmington Hills, MI, (6)Medicine, Wayne State University, Detroit, MI


    B. Kaur, None

    P. Kilgore, None

    A. Salim, None

    E. Waldman, None

    G. E. Pizzo, None

    H. Baker, None

    J. Rosenblatt, None

    K. Kaye, None

    T. Chopra, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.