Uvesh Mansuri, MD, MPH1, Achint Patel, MD, MPH2, Priyanka Chaudhari, MBBS3, Harpreet Kaur, MD4, Hardikkumar Shah, MD, MPH5, Joseph DePasquale, MD6; 1MedStar Union Memorial Hospital, Baltimore, MD; 2Sayre, PA; 3Northside Primary Care Inc., Atlanta, GA; 4BronxCare Health System, New York, NY; 5Saint Michael's Medical Center, Newark, NJ; 6Jersey City Medical Center, Jersey City, NJ
Introduction: Prior studies have shown an increase in incidence of Clostridium difficile infection (CDI) in the United States in recent years, several studies have also been done to assess trends and outcomes in different age groups. Our study aims to delineate the temporal trends, and outcomes of CDI from a Nationwide Inpatient database in the younger patient population (age < 50 years). Methods: We extracted study Cohort from National Inpatient Sample (NIS) for primary admissions due to CDI using International Classification of Diseases (9th/10th Editions) Clinical Modification diagnosis codes (ICD-9-CM/ICD-10-CM) from for the years 2007-2017. CDI and other diagnosis of interests were identified by ICD-9/10-CM codes and Elixhauser comorbidity software which has been validated in prior studies. Our primary outcomes were to study temporal trends and outcomes of CDI among the younger population (age < 50 years). We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze the trends and outcomes. Results: Out of a total 1,158,047 primary hospitalizations due to CDI, 184,752 (16%). Hospitalization due to CDI among age < 50 years increased from 12% in 2007 to 18% in 2017 (ptrend:< 0.001). CDI hospitalizations increased among younger population with a 5% yearly increase (OR 1.05; 95%CI 1.05-1.06 ;p:0.001) which persisted (OR 1.06; 95%CI 1.05-1.07 ;p:0.001)even after adjusting with demographics and comorbidities over the years. In trend analysis by different ethnicities among young CDI patients, caucasians showed marked increase from 63% in 2007 to 67% in 2017. However trends among other ethnicities remained stable over the similar study period. Moreover, in-hospital mortality (3.8% in 2007 to 1.3% in 2017; p:< 0.001) and discharge to facility (34.5% in 2007 to 23.1% in 2017; p:< 0.001) has decreased among the younger patients. Discussion: In this nationally representative study, we observed an increased incidence of CDI among the younger population over the past decade, more likely among caucasian ethnicity. We also noted an overall improvement in outcomes in this younger population. Further studies are warranted for in-depth studies to understand this trend of increased incidence among the younger population.
Figure 1: Temporal trends of Hospitalizations due to CDI bye age groups.
Figure 2: Outcomes of CDI Hospitalization in younger patients.
Disclosures: Uvesh Mansuri indicated no relevant financial relationships. Achint Patel indicated no relevant financial relationships. Priyanka Chaudhari indicated no relevant financial relationships. Harpreet Kaur indicated no relevant financial relationships. Hardikkumar Shah indicated no relevant financial relationships. Joseph DePasquale indicated no relevant financial relationships.