Clostridium Difficile Associated Colitis: A 10 year analysis of trends and characteristics

Gregory B Burgoyne, MD, Richard F Heitmiller, MD

Medstar Union Memorial Hospital

Introduction: Clostridium Difficile Associated Colitis (CDAC) has become increasingly common, sometimes resulting in hospital admission and colectomy. We reviewed a national database to determine the trends in patient characteristics, diagnoses and management.

Methods: The Nationwide Inpatient Sample was searched for all patients with CADC as a primary diagnosis (ICD-9 = 008.45) from 1999-2009. Age, sex, race, length of stay (LOS), admission month, mortality, diagnosis and procedure codes, and geographic region were recorded and analyzed. Race was compared to the race demographics of the US Census (2000-2010).

Results: A total of 750,155 patients were admitted to hospital with CDAC. Admissions increased from 30,060 in 1999 to 110,553 in 2009. The mean age (years) was 67.9 and increased from 64.9 in 1999 to 68.6 in 2009. The distribution by age group was (<50) 16.7%, (50-64) 16.8%, (65-84) 32.6% and (>=85) 33.9%. Males accounted for 35%, females 65% and this ratio was similar for all age groups. Distribution by race was 81.3% White, 8.2% Black, 7.0% Hispanic, 1.2% Asian, 0.4% Native American and 2.0% Other. After accounting for population race distribution, the admissions rates were higher for white and black patients. LOS (days) was 7.0 in 1999 and 6.9 in 2009 with a mean LOS of 7.0. LOS by age was (<50) 5.1, (50-64) 6.6, (65-84) 7.5, (>=85) 7.7. The Northeast had the highest LOS at 7.8 while the Midwest, South and West were 6.47, 7.08 and 6.69 respectively. Average mortality rate was 3.8% (range 3.35%-4.09%) which did not vary over the decade. Admission for CDAC resulted in a partial colectomy in 0.5% of patients and a total colectomy in 0.5%. March through May accounted for 26.9% of admissions while the rest of the year accounted for 73.1%.

Conclusion: CDAC has been rapidly increasing in incidence and occurs more commonly in whites and older patients. Women across all ages are twice as likely to be affected as men. Springtime is associated with higher admission rates. This may be related to other seasonal infections for which antibiotics are being prescribed. Overall LOS has not changed over the last decade but it is longer for older patients and patients in the Northeast. Even with improvements in diagnostic testing and treatment, the mortality rate remained between 3-4% over the study period. Despite thousands of admissions annually for CDAC, only 1% of patients have either a partial or total colectomy.