Increasing Prevalence and Severity of Clostridium difficile Colitis in Hospitalized Patients in the United States

Rocco Ricciardi, MD, MPH; David A. Rothenberger, MD; Robert D. Madoff, MD; Nancy N. Baxter, MD, PhD

Arch Surg. 2007;142:624-631.

Objective  To evaluate changes in the epidemiological features of Clostridium difficile colitis in hospitalized patients in the United States (C difficile is a common cause of nosocomial diarrhea that has been shown to be increasing in virulence in Canada and across Europe).

Design  Cohort analysis of all patients with C difficile colitis in the Nationwide Inpatient Sample.

Setting  Population-based data from the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts from January 1, 1993, through December 31, 2003.

Patients  Using standard International Classification of Diseases, Ninth Revision (ICD-9) diagnostic codes, we identified patients with C difficile colitis. We controlled for comorbid conditions by calculating the Deyo modification of the Charlson score. To determine the relationship of year of diagnosis on main outcome measures, we constructed multivariate models.

Main Outcome Measures  The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis.

Results  We found that the prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis increased from 1993 through 2003. In our regression analysis, the year of diagnosis predicted an increase in prevalence, case fatality, total mortality rate, and colectomy rate after adjusting for potential confounders.

Conclusions  The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis significantly increased from 1993 to 2003. These findings provide compelling evidence of the changing epidemiological features of C difficile colitis.

Author Affiliations: Departments of Surgery, University of Minnesota Medical School, Minneapolis (Drs Ricciardi, Rothenberger, Madoff, and Baxter), and St Michael's Hospital, University of Toronto, Toronto, Ontario (Dr Baxter). Dr Ricciardi is now with the Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts.