C. difficile Hospitalizations, Deaths on the Upswing

A sharp rise in the number of adult hospitalizations and deaths attributable to Clostridium difficile infection over a 6-year period has investigators calling for increased allocation of public health resources aimed at the prevention of disease caused by the GI pathogen.

In a population-based analysis of adult hospitalizations related to C. difficile-associated disease (CDAD) between 2000 and 2005, Dr. Marya D. Zilberberg of the University of Massachusetts School of Public Health and Health Sciences, Amherst, and colleagues determined that the incidence of adult CDAD hospitalizations rose from 5.5 cases per 10,000 population in 2000 to 11.2 per 10,000 population in 2005. Furthermore, the investigators reported that the CDAD-related, age-adjusted case fatality rate rose from 1.2% in 2000 to 2.2% in 2004.

“In our analysis, we detected a 23% annual increase in CDAD hospitalizations in the 6-year period from 2000 through 2005,” the investigators wrote. “Moreover, the absolute number of CDAD hospitalizations more than doubled in all age groups except the youngest, for whom they increased by 74.1% over the study period.” The rate of increase in the incidence of CDAD was steepest in the group aged 85 years and older, followed by the group aged 65–84 years, the group aged 45–64 years, and the group aged 18–44 years (Emerg. Infect. Dis. 2008;14:929–31).

The numbers help explain the increasing mortality rates related to CDAD, the authors wrote, referring specifically to a recent report documenting a 35% per year increase in the number of CDAD deaths from 1999 through 2004 (Emerg. Infect. Dis. 2007;13:1417–9). “By observing a 23% per year increase in the volume of hospitalizations with CDAD in the period 2000–2005, we demonstrate that at least half of the reported mortality increase with CDAD is due to an increase in the incidence of hospitalizations with this severe infection,” they stated, noting that the increased hospitalization likely represents the effects of increased virulence of the organism as well as growing resistance to some antibiotic treatments.

Data for the current analysis were obtained from the National Inpatient Sample, which is a 20% sample of U.S. community hospitals, weighted to provide national estimates. The investigators identified CDAD by ICD-9-CM code 8.45 for intestinal infection with C. difficile, and age-stratified the number of discharges per year.

“The rapid rate of growth of CDAD-related hospitalizations and mortality is alarming, particularly in view of the aging U.S. population,” the authors wrote. “If this rate of rise, along with the increase in virulence and diminished susceptibility to antimicrobial drug treatments, persists, C. difficile-associated disease will result not only in a considerable strain on the U.S. health care system but also in rising numbers of deaths related to this disease.” For this reason, they stressed, “research into the best preventive strategies, such as limiting the use of antimicrobial agents in both human disease and the food supply, is a public health imperative.”

A sharp rise in the number of adult hospitalizations and deaths attributable to Clostridium difficile infection over a 6-year period has investigators calling for increased allocation of public health resources aimed at the prevention of disease caused by the GI pathogen.

In a population-based analysis of adult hospitalizations related to C. difficile-associated disease (CDAD) between 2000 and 2005, Dr. Marya D. Zilberberg of the University of Massachusetts School of Public Health and Health Sciences, Amherst, and colleagues determined that the incidence of adult CDAD hospitalizations rose from 5.5 cases per 10,000 population in 2000 to 11.2 per 10,000 population in 2005. Furthermore, the investigators reported that the CDAD-related, age-adjusted case fatality rate rose from 1.2% in 2000 to 2.2% in 2004.

“In our analysis, we detected a 23% annual increase in CDAD hospitalizations in the 6-year period from 2000 through 2005,” the investigators wrote. “Moreover, the absolute number of CDAD hospitalizations more than doubled in all age groups except the youngest, for whom they increased by 74.1% over the study period.” The rate of increase in the incidence of CDAD was steepest in the group aged 85 years and older, followed by the group aged 65–84 years, the group aged 45–64 years, and the group aged 18–44 years (Emerg. Infect. Dis. 2008;14:929–31).

The numbers help explain the increasing mortality rates related to CDAD, the authors wrote, referring specifically to a recent report documenting a 35% per year increase in the number of CDAD deaths from 1999 through 2004 (Emerg. Infect. Dis. 2007;13:1417–9). “By observing a 23% per year increase in the volume of hospitalizations with CDAD in the period 2000–2005, we demonstrate that at least half of the reported mortality increase with CDAD is due to an increase in the incidence of hospitalizations with this severe infection,” they stated, noting that the increased hospitalization likely represents the effects of increased virulence of the organism as well as growing resistance to some antibiotic treatments.

Data for the current analysis were obtained from the National Inpatient Sample, which is a 20% sample of U.S. community hospitals, weighted to provide national estimates. The investigators identified CDAD by ICD-9-CM code 8.45 for intestinal infection with C. difficile, and age-stratified the number of discharges per year.

“The rapid rate of growth of CDAD-related hospitalizations and mortality is alarming, particularly in view of the aging U.S. population,” the authors wrote. “If this rate of rise, along with the increase in virulence and diminished susceptibility to antimicrobial drug treatments, persists, C. difficile-associated disease will result not only in a considerable strain on the U.S. health care system but also in rising numbers of deaths related to this disease.” For this reason, they stressed, “research into the best preventive strategies, such as limiting the use of antimicrobial agents in both human disease and the food supply, is a public health imperative.”

A sharp rise in the number of adult hospitalizations and deaths attributable to Clostridium difficile infection over a 6-year period has investigators calling for increased allocation of public health resources aimed at the prevention of disease caused by the GI pathogen.

In a population-based analysis of adult hospitalizations related to C. difficile-associated disease (CDAD) between 2000 and 2005, Dr. Marya D. Zilberberg of the University of Massachusetts School of Public Health and Health Sciences, Amherst, and colleagues determined that the incidence of adult CDAD hospitalizations rose from 5.5 cases per 10,000 population in 2000 to 11.2 per 10,000 population in 2005. Furthermore, the investigators reported that the CDAD-related, age-adjusted case fatality rate rose from 1.2% in 2000 to 2.2% in 2004.

“In our analysis, we detected a 23% annual increase in CDAD hospitalizations in the 6-year period from 2000 through 2005,” the investigators wrote. “Moreover, the absolute number of CDAD hospitalizations more than doubled in all age groups except the youngest, for whom they increased by 74.1% over the study period.” The rate of increase in the incidence of CDAD was steepest in the group aged 85 years and older, followed by the group aged 65–84 years, the group aged 45–64 years, and the group aged 18–44 years (Emerg. Infect. Dis. 2008;14:929–31).

The numbers help explain the increasing mortality rates related to CDAD, the authors wrote, referring specifically to a recent report documenting a 35% per year increase in the number of CDAD deaths from 1999 through 2004 (Emerg. Infect. Dis. 2007;13:1417–9). “By observing a 23% per year increase in the volume of hospitalizations with CDAD in the period 2000–2005, we demonstrate that at least half of the reported mortality increase with CDAD is due to an increase in the incidence of hospitalizations with this severe infection,” they stated, noting that the increased hospitalization likely represents the effects of increased virulence of the organism as well as growing resistance to some antibiotic treatments.

Data for the current analysis were obtained from the National Inpatient Sample, which is a 20% sample of U.S. community hospitals, weighted to provide national estimates. The investigators identified CDAD by ICD-9-CM code 8.45 for intestinal infection with C. difficile, and age-stratified the number of discharges per year.

“The rapid rate of growth of CDAD-related hospitalizations and mortality is alarming, particularly in view of the aging U.S. population,” the authors wrote. “If this rate of rise, along with the increase in virulence and diminished susceptibility to antimicrobial drug treatments, persists, C. difficile-associated disease will result not only in a considerable strain on the U.S. health care system but also in rising numbers of deaths related to this disease.” For this reason, they stressed, “research into the best preventive strategies, such as limiting the use of antimicrobial agents in both human disease and the food supply, is a public health imperative.”