Table 3. Multicenter Studies (≥5 Sites) That Evaluated Clostridium difficile Infection Incidence Using Incident Cases.
| Source | Data Set | Study Period | Facilities or Hospitals, No. | C difficile Definition | Incidence |
|---|---|---|---|---|---|
| HO infections | |||||
| Barber et al,43 2018 | AHRQ NIS patients with inflammatory bowel disease | 1998-2014 | Approximately 1000 hospitals | ICD-9 | Incidence of HO-CDI, 7.8 cases/1000 hospitalizations in 1998 and 32.1 cases/ 1000 hospitalizations in 2014 among patients with Crohn disease, and 23.0 cases/1000 hospitalizations in 1998 and 84.7 cases/1000 hospitalizations in 2014 among patients with ulcerative colitis |
| Barlam et al,44 2018 | Truven Health Marketscan Commercial Claims and Encounters database | 2011-2013 | This database represents approximately 50 million covered lives (annually) for employed subscribers aged <65 y and their dependents | ICD-9 | 4 080 597 Unique individuals aged 1-64 y were admitted to the hospital in 2011; 12 025 had ≥1 C difficile diagnosis and complete enrollment information for 2011 (12 025 / 4 080 597 = 0.29%) |
| Bhandari et al,45 2018 | AHRQ NIS database | 2007-2011 | 20% Stratified sample of US community hospitals | ICD-9 | Incidence of HO-CDI was 2.13% among patients with lymphoma and 0.8% among patients without lymphoma |
| Brown et al,46 2017 | VA health care system | January 2006- December 2012 | 131 Acute care facilities | Laboratory tests | 15.6 CDI cases/10 000 person-days |
| Dasenbrock et al,47 2016 | AHRQ NIS patients with subarachnoid hemorrhage who underwent microsurgical or endovascular aneurysm repair | 2002-2011 | Approximately 1000 hospitals | ICD-9 | Incidence of HO-CDI was 1.9% |
| Davis et al,48 2018 | Electronic medical record of the health system | 2014-2016 | 5-Hospital health system in Houston, Texas | Laboratory tests | Incidence of HO-CDI was 1.52% |
| Delgado et al,49 2017 | US NHDS | 2001-2010 | Not stated | ICD-9 | Incidence of HO-CDI was 8.6 cases/1000 cancer discharges |
| Dotson et al,50 2018 | AHRQ NIS patients with chronic liver disease | 2009 | Approximately 1000 hospitals | ICD-9 | Incidence of HO-CDI was 189.4 cases/10 000 discharges |
| Guddati et al,51 2014 | AHRQ NIS database | 2000-2009 | 20% Stratified sample of US community hospitals | ICD-9 | Incidence of HO-CDI among hematopoietic stem cell transplant recipients was 4.7%; nontransplant discharges were 0.86 cases/100 hospitalized patients |
| Gupta et al,52 2016 | US NHDS | 2005-2009 | Not stated | ICD-9 | Overall HO-CDI incidence in children was 33.5 cases/10 000 hospitalizations |
| Gupta et al,53 2017 | US NHDS | 2001-2010 | 100 Hospitals | ICD-9 | Incidence of HO-CDI in patients with cancer was 64.7 cases/10 000 discharges in 2001-2002 and 109.1 cases/10 000 discharges in 2009-2010 |
| Jiang et al,54 2013 | Rhode Island Hospital Discharge Database | 2010-2011 | 11 Hospitals | ICD-9 excluding present on admission code | HO-CDI, 1211 infections among 225 999 discharges = 53.5 cases/10 000 discharges |
| Khanna et al,55 2016 | US NHDS | 2005-2009 | 100 Hospitals | ICD-9 | HO-CDI incidence was 77.8 cases/10 000 hospitalizations |
| Kuy et al,56 2016 | AHRQ NIS patients with both C difficile and megacolon | 2000-2010 | Approximately 1000 hospitals | ICD-9 | Overall incidence of megacolon among all hospitalized patients was 0.02% from 2000 to 2010; percentage of cases of megacolon due to CDI was 3.61% in 2000 and 9.39% in 2010 |
| Lessa et al,57 2015 | Centers for Disease Control and Prevention Emerging Infections Program | 2011 | 10 Program sites across 34 counties | Laboratory tests | 453 000 Incident infections |
| Luo et al,58 2015 | AHRQ NIS patients with CDI with leukemia | 2005-2011 | Approximately 1000 hospitals | ICD-9 | Overall incidence of CDI among patients with leukemia, 3.4%; incidence of CDI among all hospitalized patients, 0.85%; incidence of CDI among patients with leukemia in 2005, 3.0%; incidence of CDI among patients with leukemia in 2011, 3.5% |
| Mamic et al,59 2016 | AHRQ NIS database | 2012 | 20% Stratified sample of US community hospitals | ICD-9 | HO-CDI incidence among patients with a discharge diagnosis of heart failure, 3.5% |
| Miller et al,60 2016 | Healthcare Cost and Utilization Project State Inpatient Database for California | 2005-2011 | 480 Hospitals | ICD-9 | Overall incidence of HO-CDI, 0.15 cases/100 patients |
| Miller et al,61 2016 | AHRQ NIS database | 2009-2011 | 480 Hospitals | ICD-9 | HO-CDI incidence, 0.85 cases/100 patients in 2009, 0.89 cases/100 patients in 2010, and 0.99 cases/100 patients in 2011 |
| Pant et al,62 2016 | Kids’ Inpatient Database (Healthcare Cost and Utilization Project) | 2003-2012 | Contains data from a variety of hospitals, including nonfederal, short-term, general, and special hospitals (including children’s hospitals) accessible by the general public | ICD-9 | Incidence rate of CDI increased from 24.0 to 58.0 cases/10 000 discharges per year (P < .001) across all age groups, with the greatest increase in children aged ≥15 y |
| Pant et al,63 2016 | 2012 | Rate of CDI infection in children without solid-organ transplant was 0.6% and was greater (3.6%) in children with solid-organ transplant | |||
| Reveles et al,64 2014 | US NHDS of hospitalized adults | 2001-2010 | 100 Hospitals | ICD-9 | Incidence of HO-CDI, 4.5 cases/1000 adult discharges in 2001 and 8.2 cases/1000 adult discharges in 2010 |
| Saffouri et al,65 2017 | US NHDS inflammatory bowel disease hospitalizations | 2005-2009 | 100 Hospitals | ICD-9 | Overall incidence of HO-CDI was 369.8 cases/10 000 inflammatory bowel disease hospitalizations; HO-CDI incidence was 445.6 cases/10 000 ulcerative colitis hospitalizations and 220.3 cases/10 000 Crohn disease hospitalizations |
| Sammons et al,66 2013 | Pediatric Health Information System Database | 2006-2011 | 41 Pediatric hospitals | ICD-9 and positive test for CDI | 5107 Cases/693 516 patients; 73.6 cases/10 000 patients |
| Murphy et al,67 2012 | California hospital discharge data | 2000-2007 | 29 Hospitals | ICD-9 | 28.7 Cases/10 000 admissions in 2000 and 52.2 cases/10 000 admissions in 2007 |
| Kuntz et al,68 2010 | AHRQ NIS women hospitalized for childbirth and delivery | 1998-2006 | 20% Stratified sample of discharges from nonfederal acute care hospitals | ICD-9 | CDI incidence ranged from 0.36 CDI cases/10 000 peripartum women in 1998 to 0.70 CDI cases/10 000 peripartum women in 2006 |
| Denominator: surgical patients | |||||
| Aquina et al,69 2016 | Statewide Planning and Research Cooperative System (a hospital discharge database by the New York Department of Health) | 2005-2013 | Patient-level data for all hospital admissions, ambulatory surgery procedures, and emergency department visits within New York State | ICD-9 | 22 Cases of CDI/1000 discharges |
| Bovonratwet et al,70 2018 | American College of Surgeons National Surgical Quality Improvement Program database | 2015 | 500 Institutions | Clinical findings, laboratory tests | 0.11% of the population had postoperative CDI |
| Bovonratwet et al,71 2018 | American College of Surgeons National Surgical Quality Improvement Program database | 2015 | 500 Institutions | Clinical findings, laboratory tests | A total of 73 patients had C difficile colitis, generating an incidence of 1.05% (adult elderly, surgical patients [hip fracture]) |
| Bovonratwet et al,72 2018 | The incidence of C difficile colitis was 0.10% (adult nonelderly and elderly, surgical patients [hip and knee arthroplasty]) | ||||
| Delanois et al,73 2018 | AHRQ NIS database | 2009-2013 | Not stated | ICD-9 | After revision total hip arthroplasty, 1.7% of patients had postoperative CDI |
| Englesbe et al,74 2010 | Michigan Surgical Quality Collaborative and American College of Surgeons-National Surgical Quality Improvement Program on colectomy operations | 2007-2009 | 24 Hospitals | Not stated | Among patients undergoing colectomies who received nonabsorbable antibiotics for bowel preparation, 1.9% had postoperative CDI; among patients undergoing colectomies who did not receive nonabsorbable antibiotics for bowel preparation, 3% had postoperative CDI |
| Lesperance et al,75 2011 | AHRQ NIS patients who underwent elective colon resections | 2004-2006 | Approximately 1000 hospitals | ICD-9 | Overall, 1.4%; 2004, 1.31%; 2005, 1.45%; 2006, 1.67% |
| Guzman et al,76 2016 | AHRQ NIS patients who underwent cervical spine surgery | 2002-2011 | Approximately 1000 hospitals | ICD-9 | Overall incidence of CDI in postoperative cervical spine surgery hospitalizations, 0.08%; in 2011, 0.14% |
| Gwam et al,77 2018 | AHRQ NIS database | 2009-2013 | Not stated | ICD-9 | Incidence of CDI after revision total knee arthroplasty, 1.0% |
| Maltenfort et al,78 2013 | AHRQ NIS database | 2002-2010 | Not stated | ICD-9 | Incidence of C difficile remained <0.6% during the study period |
Abbreviations: AHRQ, Agency for Healthcare Research and Quality; CDI, Clostridium difficile infection; HO, hospital onset; ICD-9, International Classification of Diseases, Ninth Revision; NHDS, National Hospital Discharge Survey; NIS, National Inpatient Sample; VA, Veterans Affairs.