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BACKGROUND: Clostridium difficile (C. diff) is a common cause of healthcare-associated infections. The Pennsylvania Health Care Cost Containment Council (PHC4) collects hospital discharge data from all (non-Federal) hospitals in Pennsylvania, and creates de-identified datasets for use by researchers. We gathered 14 years of PHC4 hospital discharge data to describe characteristics of hospitalized C. diff cases and to examine trends in C. diff in Pennsylvania.
METHODS: State-wide hospital discharge datasets from 2000 to 2013 were obtained from PHC4. C. diff-associated hospitalizations were defined as having the ICD-9-CM code ‘008.45’ in any one of nine discharge diagnosis fields. Patient pseudo-IDs were used to identify readmissions for individual patients. Hospitalizations were characterized as to year, age and sex of patient, length of hospital stay, and discharge status. Intercensal population estimates from the Pennsylvania Department of Health were used to calculate incidence rates.
RESULTS: From 2000 to 2013, a total of 248,737 C. diff-associated hospitalizations were identified. Among these, 110,518 (44%) had C. diff listed as the primary or secondary discharge diagnosis. C. diff-associated hospitalizations increased from 10,718 in 2000 to a peak of 23,038 in 2005, and have been generally decreasing since then, with 19,127 hospitalizations reported in 2013. Incidence of C. diff-associated hospitalizations was 8.7/10,000 in 2000, 18.5/10,000 in 2005, and 15.0 in 2013. Incidence increased by age, ranging from 2.1/10,000 in those <10 years old to 81.6/10,000 in those over 70 years. The median age was 74 years. Hospitalized patients were more likely to be male (57.0%) than female (43%). Median length of stay was 8.0 days. Patient re-admission rate over 6 months was 22.4 %.
CONCLUSIONS: Although there have been improvements since 2005, hospitalizations associated with C. diff infections continue to be substantially elevated in Pennsylvania compared to 14 years ago. Rates were highest among the elderly. Median length of stay was over a week, and nearly a quarter of patients were readmitted within a few months. To reduce disease burden and health-care costs, increased C. diff prevention and infection-control efforts should be directed toward high-risk populations, such as the elderly.