Background
The incidence of community-acquired Clostridium difficile (CACD) is increasing in the US. Many CACD infections occur in the elderly who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries.
Study Design
We queried a 5% random sample of Medicare beneficiaries (2009–2011 Part A inpatient and Part D prescription drug claims, N=864,604) for any hospital admission with a primary ICD-9 diagnosis code for C. difficile (008.45). We examined patient sociodemographic and clinical characteristics, pre-admission exposure to oral antibiotics, prior treatment with oral vancomycin or metronidazole, inpatient outcomes (colectomy, ICU stay, length of stay, mortality), and subsequent admissions for C. difficile.
Results
A total of 1566 (0.18%) patients were admitted with CACD. Of these, 889(56.8%) received oral antibiotics within 90 days of admission. Few were being treated with oral metronidazole (N=123, 7.8%) or vancomycin (N=13, 0.8%) at the time of admission. While 223(14%) patients required ICU admission, few (N=15, 1%) underwent colectomy. Hospital mortality was 9%. Median length of stay (LOS) among survivors was 5 days (IQR 3–8). One- fifth of survivors were re-admitted with C. difficile with a median follow up time of 393 days (IQR 129–769).
Conclusions
Nearly half of Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and re-admission rates suggest that the burden of C. difficile on patients and the healthcare system will increase as the US population ages. Additional efforts at primary prevention and eradication may be warranted.
