Trends in admissions and outcomes of hospitalizations related to Clostridioides difficile infection: a nationwide analysis from 2005-2020

Abstract

Background Clostridioides difficile infection (CDI) is one of the major causes of healthcare-associated infectious colitis. This study analyzed trends in CDI-related hospitalizations in the United States (US) from 2005-2020, focusing on changes in patient demographics, disease severity and outcomes.

Methods Our study was a retrospective observational analysis using the National Inpatient Sample (NIS) from 2005-2020, focusing on US adults with primary and secondary CDI diagnoses. We performed statistical analysis using SAS 9.4 and joinpoint regression models to identify trends and changes in CDI prevalence and severity, as well as patient outcomes, over the 15-year period.

Results The study analyzed 939,282 patients, 30.2% of whom had primary and 69.8% secondary CDI diagnoses. Over the study period, there was a decline in CDI prevalence from 94.8 to 78.1 per 10,000 hospitalizations. This trend showed an increase in prevalence among younger adults (18-34 years) but a notable decrease in older adults (≥85 years). Sex-related and racial/ethnic disparities were also evident. The incidence of megacolon surged from 12.9 per 10,000 hospitalizations in 2005 to 69.8 per 10,000 in 2020, a more than fivefold increase. In contrast, in-hospital mortality from CDI significantly decreased, from 1028 deaths per 10,000 CDI diagnoses in 2005 to 687 per 10,000 in 2020, a 33.1% reduction.

Conclusions Our study indicated improved management and prevention of CDI, as evidenced by the overall decrease in prevalence and mortality. However, the increase in severity markers and the variable trends across different demographic groups highlight the need for ongoing vigilance and targeted interventions.

Keywords Clostridioides difficile, epidemiology, hospitalization, mortality, severity

Ann Gastroenterol 2025; 38 (3): 311-318