Clostridium difficile in a population of hospital discharges: Examining differences in patients admitted with or without the infection

Background and Objective: Clostridium difficile (C. difficile) is a dangerous, potentially life- threatening, healthcare-associated infection (HAI). Its clinical manifestations vary from an asymptomatic presentation to severe pseudo-membranous colitis. The incidence of C. difficile among US hospital discharges has increased in recent years, and these newer cases of C. difficile tend to be both more severe and more resistant to treatment. This study explores the incidence of hospital acquired C. difficile infections in Texas hospitals during 2011.  We investigate which individual characteristics increase the likelihood a patient admitted to hospital without a diagnosis of C. difficile infection will acquire the infection before discharge.  We compare these characteristics with those of patients who acquired the infection prior to their hospital admission.  We also investigate the relative importance of individual characteristics and the site of care in modeling the likelihood of acquiring C. difficilein hospital.

Research Design and Methods: This research used 2011 Texas inpatient discharge data. We present descriptive data on individual and facility characteristics of inpatients that acquired C. difficile in the hospital or had a diagnosis of C. difficile on admission. We then use logistic regression to evaluate the likelihood that a patient admitted to n the hospital will acquire C. difficile.

Results: Of all those who acquired C. difficile in the hospital, 69 percent were over 65 and less than 2 percent were under 18 years of age. Fifty-five percent of these patients were females, and majority were white (68 percent). Multivariate analyses reveal that individual characteristics are more predictive of the likelihood that someone admitted into the hospital will acquire C. difficilethan are facility characteristics.

Conclusions: These results indicate that the driving factors of hospital acquired C. difficile may be more attributable to individual characteristics than hospital characteristics. This finding may be of considerable importance as payers introduce performance-based reimbursement measures that often include non-payment for hospital-acquired infections. Within such systems, the use of measures largely driven by individual characteristics is far from ideal. Other measures may merit consideration in the reimbursement for the care of patients with hospital-acquired C. difficile.