Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in the United States. The aims of this cross-sectional population-based study are to determine overall Incidence rate of CDI in the State of South Carolina and estimate the healthcare and financial burden of community-associated C. difficile infection (CA-CDI).
South Carolina CDI initiative identified CDI cases from National Healthcare Safety Network (NHSN), and the South Carolina Infectious Disease and Outbreak Network (SCION) from January 1, 2015 to June 30, 2016 through complete enumeration of the state's population, excluding infants <1 year old. A positive stool C.difficile test was regarded as a “CDI case” for purposes of this study. Only first and recurrent episodes after 8 weeks of initial one were included in this analysis.
During the 18-month study period, 10,254 unique CDI events were identified in South Carolina residents ≥1 year old. Over one-half of CDI cases were CA-CDI (5192; 51%), 2678 (26%) were community-onset healthcare facility associated (CO-HCFA), and 2384 (23%) were hospital-onset (HO) cases. Overall incidence rate of CDI in South Carolina per 100,000 person-years was 141 (71, 37, and 33 for CA-CDI, CO-HCFA CDI, and HO-CDI, respectively). Among 5192 episodes of CA-CDI, 2127 (41%) required hospitalization with a median length of stay of 5 days and median cost of $31,270. Additionally, 574 (11%) of CA-CDI cases were treated in emergency rooms without admission to the hospital. The annual burden of CA-CDI on the South Carolina's healthcare system was estimated at 387 ambulatory emergency room visits and 9,282 hospital days. The estimated annual hospital charges for patients with CA-CDI in South Carolina were $68,491,046.
The incidence rate of CA-CDI in South Carolina has surpassed both CO-HCFA CDI and HO-CDI combined. The heavy burden of CA-CDI justifies dedication of public health resources to combat CDI in ambulatory settings. Antimicrobial stewardship initiatives targeting unnecessary and inappropriate antimicrobial use in the community may reduce the burden of CDI in South Carolina.
S. Weissman, None
L. Bell, None
A. Maki Jr., None
K. S. Waites, None
S. Dash, None
M. N. Al-Hasan, None