Background:

Studies have identified that CDI incidence has increased or even doubled between 2001 and 2010. While the 2013 National Standardized Incidence Ratio (SIR) showed a decrease of hospital onset CDI (CDI-HO) from the 2011 baseline, there were significant differences at the state level. As costs, rates of infections, and risk of readmission for CDI vary significantly by region, it is difficult for hospitals to assess their comparative burden of recurrent CDI (rCDI) and resulting economic and clinical consequences This study investigates the regional variation in patient outcomes and treatment costs for CDI patients admitted to an acute care hospital using the Premier Healthcare Database, a geographically diverse database of US acute care hospitals

Methods:

All inpatient discharges between January 1, 2010 and December 31, 2013 who were given a diagnosis code of 008.45 and received metronidazole, vancomycin, or fidaxomicin were included in the sample. Initial CDI (iCDI) and subsequent readmissions were defined as readmissions that occurred within six weeks of the iCDI or initial readmission discharge dates. Unadjusted comparisons between CDI-COM (community onset CDI) and CDI-HO patients were performed for hospital characteristics, patient demographics, comorbidities, and outcomes. Bivariate and multivariate analyses were used adjusting for confounders with p<0.05 used as statistically significant

Results:

Results

There were180,371 eligible discharges (17.3% CDI-HO and 82.7% CDI-COM). CDI-COM increased between 2010 and 2013, but with reductions in the Middle Atlantic, Pacific, and West North Central regions.  CDI-HO fell overall but increased in the East South Central, Mountain, New England, and West South Central regions. Smaller hospitals (Bed size < 250) tended to have higher CDI-COM rates. Large (Bed size > 550), urban and teaching hospitals had higher CDI-HO rates. Compared to CDI-COM, CDI-HO patients had higher inpatient mortality rates (9.5% CDI-HO vs. 7.6% CDI-COM), transfers to SNF (44.6% vs. 36.3%), mechanical ventilation (30.1% vs. 13.3%), ICU admission (46.6% vs.27.6%), longer length of stay (LOS) (20.8 days vs.10.0 days) and greater hospital cost ($49,668 vs. $20,378). However, CDI-COM patients had higher rates of first rCDI, inpatient admissions (13.9% vs. 10.8%) and subsequent readmissions (2.9% vs. 2.1%).

Adjusting for patient demographics, comorbidities and hospital type, patients in the East North Central region had a lower estimated LOS and the Middle Atlantic had the longest. Similarly, the East North Central and East South Central regions had the lowest adjusted costs while the Middle Atlantic and Pacific had the highest. This was consistent across CDI-COM and CDI-HO. 

Conclusions:

Regional variations exist in trends of CDI prevalence as well as outcomes. . These findings may be useful in assisting individual hospitals assess their specific anticipated costs and utilization based on regional status and hospital characteristics