OBJECTIVES: Clostridioides difficile infections (CDI) are the most common healthcare–associated infections in the US with significant recurrence, morbidity and mortality. This study analyzed a contemporary hospital database to determine the inpatient mortality, number and cost of hospitalizations including re-hospitalizations for inpatients with CDI diagnosis.

METHODS: Study Design and Data: Retrospective, longitudinal analysis of the Premier Healthcare Database, a large hospital-based, all-payer database representing a quarter of annual inpatient admissions in the US. Patient Inclusion Criteria: Hospitalization (index-CDI hospitalization) with a primary or secondary ICD-10-CM discharge diagnosis of CDI during study period and no CDI-related hospitalizations in the prior year. Outcomes (12-month after index): all-cause inpatient mortality, re-hospitalizations, and hospitalization costs; the latter two of which were considered CDI-related if the discharge diagnoses included CDI.

RESULTS: A total of 108,329 patients met study inclusion criteria with mean age of 66 years. During 12-month follow-up after index CDI hospitalization, 21% (N=22,987), 10% (10,395), and 11% (12,096) of patients had either 1, 2, or 3+ all-cause re-hospitalizations respectively; of which 45%, 25%, and 18% were CDI-related. Overall, 11% died. During the index CDI hospitalization, 6.4% died, and 6.8%, 5.7% and 4.2% died for 1st, 2nd, and 3rd CDI-related re-hospitalization. While average index CDI hospitalization cost was $25,691, cumulative CDI-related hospital costs for patients with 1, 2, 3, and 4+ CDI-related re-hospitalizations was $43,601, $60,996, $78,356, and $110,618, respectively.

CONCLUSIONS: Inpatient costs, re-hospitalization and mortality for hospitalized patients with CDI are substantial. Hospital costs increase significantly as the number of CDI-related hospitalizations increase. Treatments that prevent CDI re-hospitalizations are needed to reduce inpatient mortality and cost.