914. Prevalence, Hospital Length of Stay (LOS), and Costs of Clostridium difficile Infection (CDI) among Non-maternal Adult Hospital Discharges (NAHD) in the US, 2001-2012
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall

Clostridium difficileis the leading bacterial cause healthcare-associated diarrhea. CDI has been targeted by CMS and private payers for reduction under various payment incentive programs.  Previous studies have focused on disease incidence in the general population. This study describes the overall disease burden and trend in terms of prevalence, LOS, and costs of CDI among non-maternal adult hospital discharges in the United States from 2001-2012.


Data included discharge records of all hospitalized patients in the Healthcare Costs and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) from 2001 to 2012. Non-maternal discharges were identified by excluding major diagnostic category (MDC) code of 14.  ICD-9 CM codes were used to identify CDI (008.45). Charges were converted to costs using the HCUP Cost-to-Charge ratio files and adjusted for inflation.  Unadjusted and multi-variate adjusted LOS and costs were estimated. Unadjusted analyses by primary expected payer were performed on the 2012 data.


NAHD with CDI were older, sicker, and were predominantly white, males from the South with higher income (>$48,000) compared to those without CDI (all p values were <0.0001).  Fewer patients with CDI had no insurance (2.74%) compared to those without CDI (6.56%).  There was a 2.11 fold increase in CDI prevalence, from 53.89 in 2001 to 131.89 per 10,000 discharges in 2012 (p<0.0001).  LOS for CDI has decreased from 8.39 in 2001 to 5.76 days in 2012 (p<0.0001). Costs for CDI have decreased from $13309.00 in 2001 to $10644.73 in 2012 (p=0.0005). Data by payer are shown in Table 1. Both unadjusted and adjusted analyses showed the same trend.

Table 1. Prevalence, LOS and Cost for CDI by primary expected payer, 2012












LOS, days





Cost ($)





1Per 10,000 discharges. *p<0.0001.


CDI prevalence has increased significantly, while LOS and costs have decreased. Improved diagnosis may have lead to greater treatment efficiency or resulted in shifting patients to outpatient settings.  LOS and costs were higher in CDI patients with Medicaid, even though there were more cases in the Medicare population.

Emelline Liu, MSHS1, Ruiqi Cen, MPH2, Qian Shi, MPH2, Michele Schoonmaker, PhD1 and Lizheng Shi, PhD2, (1)Cepheid, Sunnyvale, CA, (2)Global Health Systems and Development, Tulane University, New Orleans, LA


E. Liu, Cepheid: Collaborator , Salary

R. Cen, None

Q. Shi, None

M. Schoonmaker, None

L. Shi, None

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