Burden of Hospital-Onset Clostridium difficile Infection in Patients Discharged from Rhode Island Hospitals, 2010–2011: Application of Present on Admission Indicators

Abstract

Objective.The year 2010 is the first time that the Rhode Island hospital discharge database included present on admission (POA) indicators, which give us the opportunity to distinguish cases of hospital-onset Clostridium difficile infection (CDI) from cases of community-onset CDI and to assess the burden of hospital-onset CDI in patients discharged from Rhode Island hospitals during 2010 and 2011.Design.Observational study.Patients.Patients 18 years of age or older discharged from one of Rhode Island's 11 acute-care hospitals between January 1, 2010, and December 31, 2011.Methods.Using the newly available POA indicators in the Rhode Island 2010 and 2011 hospital discharge database, we identified patients with hospital-onset CDI and without CDI. Adjusting for patient demographic and clinical characteristics using propensity score matching, we measured between-group differences in mortality, length of stay, and cost for patients with hospital-onset CDI and without CDI.Results.In 2010 and 2011, the 11 acute-care hospitals in Rhode Island had 225,999 discharges. Of 4,531 discharged patients with CDI (2.0% of all discharges), 1,211 (26.7%) had hospital-onset CDI. After adjusting for patient demographic and clinical characteristics, discharged patients with hospital-onset CDI were found to have higher mortality rates, longer lengths of stay, and higher costs than those without CDI.Conclusions.Our results highlight the burden of hospital-onset CDI in Rhode Island. These findings emphasize the need to track longitudinal trends to tailor and target population-health and quality-improvement initiatives.