Background. There has been an alarming uptrend in the number of cases of C. difficile infection (CDI) after the introduction of real-time PCR based diagnostic testing. The objective of this study was to interrogate a nationwide emergency department (ED) database to determine the trend of ED visits related to CDI for the years 2006-2010.
Methods. Data were obtained from the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality for the years 2006-2010. Data were weighted to generate national-level estimates.
Results. For years 2006–2010, a weighted total of 462,160 patients were discharged from the ED with a primary diagnosis of CDI. The rate (cases/100,000 population) of ED visits with CDI as a primary diagnosis increased from 34.08 in 2006 to 42.37 in 2010; this represented an increase of 24.32% (P < 0.01). There was an increased trend in the number of ED visits with CDI as a primary diagnosis from 2006–2010 (P < 0.01). The highest incidence rate of CDI related ED visits was observed patients ≥ 65 years, while the lowest incidence was in patients 18–24 years. Of the 462,160 patient cohort, 92.48% of cases were admitted as inpatients to the hospital. 17,638 of these patients (4.1%) died during the hospital admit. Inpatient and ED charges increased during the period of the study, from a median of $20,000 (interquartile range [IQR] $25,000) to $24,000 (IQR $27,000) (P < 0.01). LOS remained constant at a median of 5 days (IQR 5 days) for this period. Factors associated with an increased risk of hospital admission included female sex, a comorbid burden of ≥3 (aOR 8.25 95% CI 7.89 – 8.62), age ≥65 years (aOR 3.13 95% CI 2.95 – 3.32) and presentation to a metropolitan facility (aOR 2.77 95% CI 2.69 – 2.85). Much smaller risks were associated with female gender (aOR 1.12 95%CI 1.09 – 1.15), Medicaid or Medicare insurance (aOR 1.21 95% CI 1.18 – 1.25), and presentation to a facility in the Southern region of the United States (aOR 1.06 95% CI 1.02 – 1.09).
Conclusion. CDI related ED visits represent a considerable burden on the healthcare system in the United States. Additionally, an increasing trend in the incidence of these cases was observed for the years 2006–2010.
Disclosures. All authors: No reported disclosures.