Clostridioides difficile infection in US hospitals: a national inpatient sample study



Hypervirulent strains of Clostridioides difficile have altered the landscape of hospital and community outbreaks. We aim to examine and compare spatiotemporal trends, incidence, hospital teaching status, mortality, and cost associated with hospital-acquired Clostridioides difficile infection (HCDI) and community-acquired Clostridioides difficile infection (CCDI).


Retrospective cohorts were studied using data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) from 2006 to 2015.


A total of 76,124 cases of HCDI and 190,641 cases of CCDI were identified within the study period. The incidence of HCDI decreased from 8555 in 2006 to 7191 in 2015. Mortality also decreased during the same period (5.9% in 2006 to 1.4% 2015, p < 0.0001). Conversely, CCDI cases increased from 13,823 in 2006 to 20,637 in 2015. CCDI mortality decreased during the same period (4.3% in 2006 to 1.9% 2015, p < 0.0001). Rural hospital centers experienced the sharpest decline in HCDI mortality compared to urban and urban teaching centers (3.8%, p < 0.0001 vs 2.8%, p < 0.0001 vs 2.1%, p < 0.0001). Multivariate logistic regression indicated that increasing age (p = 0.0001), increasing hospital length of stay (p = 0.0001), and Medicare insurance (p = 0.002) were significant predictors of mortality for CDI mortality. Geospatial mapping of CCDI and HCDI revealed that the Eastern and Southern US experienced the largest incidence of CDI over 10 years.


The incidence of HCDI has decreased in the past decade while the incidence of CCDI hospitalization is sharply on the rise. While hospital length of stay and mortality has decreased over time, the cost of treating CDI remains high.

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Author information




DR: conception of idea and study design.

DR, PF: statistical analysis and interpretation of results.

DR, KPDH, CL, AO: drafting of manuscript.

EO, AA, MB, MR, JG: critical revision of the article for important intellectual content.

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Correspondence to Daryl Ramai.

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Ramai, D., Dang-Ho, K.P., Lewis, C. et al. Clostridioides difficile infection in US hospitals: a national inpatient sample study. Int J Colorectal Dis 35, 1929–1935 (2020).

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  • Community acquired clostridioides difficile infection (CCDI)
  • Clostridioides difficile
  • Health care cost and utilization project (HCUP)
  • Hospital-aquired clostridioides difficile infection (HCDI)
  • National inpatient sample (NIS)