Recent Epidemiology and Outcome of Clostridium difficile Infection in Community Hospital

Background: Clostridium difficile (C.difficile) infection is the most common health care associated infection of the gastrointestinal tract, affecting more than 3 million patients per year in the United States, and is associated with significant morbidity and mortality. The incidence of C.difficile infection has continued to increase over the past few years. We noticed an increase in the number of patients with C.difficile in our institution at the end of 2008 and in 2009 which prompted this study.

Objective: Review the epidemiology and predictors for adverse outcomes in our institution.

Methods: We retrospectively reviewed the charts of the patients admitted to Long Island College Hospital from January 2008 to May 2009 whose stool tests were positive for C.difficile infection. All the patients with positive stool C.difficile toxin during the study period were included.

Results: There were a total of 268 patients who had a positive C.difficile toxin test. Mean age was 65 years with 45% male and 55% female. Average length of stay in hospital was 18 days. 18% (49/268) of the patients died (age ranged from 36 to 99 years) and of these 87% (43/49) died within 30 days of the diagnosis of C.difficile infection. 12.6% (34/268), 53% (142/268) and 34% (92/268) were classified as community onset, health care facility onset and community onset health care facility associated infection respectively. Diabetes 32% (85/268), proton pump inhibitors (ppi) used 28% (76/268) and steroid used 19% (51/268) were three most commonly associated risk factors and were associated with increased rates of recurrence and death. 72% (195/268) of the patients had history of recent antibiotic exposure (within 8 weeks). Beta lactams (63%, 171/268) and quinolones (31.7%, 85/268) were the two most commonly used antibiotics. 30.2% (81/268) of the patients had signs and symptoms of systemic inflammatory response, 16.4 % (44/268) had sepsis, 10.8% (29/268) had hypotension and 15.5% (38/244) of the patients experienced renal problems (acute renal failure or injury) secondary to C.difficile infection. 23% of the patients had white cell count of more than or equal to 15.

Conclusions: Despite awareness and treatment, C.difficile infection remains a highly lethal disease. Our study suggested that diabetes, ppi and steroid used were possible predictors for recurrence and mortality. However, further studies are needed to confirm our findings, predictor for recurrence and mortality.