Aims

To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM).

Methods

A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001–2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM.

Findings

In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001–2003 to 12.97 cases per 100,000 inhabitants in 2013–2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56–0.65).

Conclusion

CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

中文翻译：

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2001年至2015年间西班牙难辨梭状芽胞杆菌相关的住院治疗和院内死亡危险因素

目的

研究2001年至2015年艰难梭状芽胞杆菌感染（CDI）住院期间的发病率，特征和住院结局趋势，根据CDI的诊断位置（主要或次要）比较患者的临床变量，并确定相关因素院内死亡率（IHM）。

方法

使用2001-2015年西班牙国家医院出院数据库进行了回顾性研究。研究人群包括出院报告中以CDI作为主要或次要诊断的患者。计算年度住院率，并使用Poisson回归模型和Jointpoint分析评估趋势。进行多变量logistic回归模型以识别与IHM相关的变量。

发现

总共确定出院49,347例出院（女性为52.31％，以CDI为主要诊断因素为33.69％）。住院率从2001–2003年的每100,000居民3.9例增加到2013–2015的每100,000居民12.97例。CDI的严重程度和每名患者的平均费用分别从6.36％和3750.11€增加到11.19％和4340.91€，而IHM从12.66％减少到10.66％。初次诊断为CDI的患者的年龄，Charlson合并症指数，严重程度，住院时间和平均费用均显着较高。无论CDI的诊断位置如何，IHM均与男性，年龄，合并症，再入院和CDI的严重程度有关。CDI的初步诊断与较低的IHM相关（赔率0.60； 95％置信区间0.56-0.65）。

结论

尽管近年来IHM有所下降，但与CDI相关的住院率正在增加，导致高昂的费用负担。在预防和管理CDI的策略中应考虑与IHM相关的因素。