Trends in Hospital Cases of Clostridioides Difficile Infection in Germany

OBJECTIVES:

A declining incidence of Clostridioides difficile infection (CDI) was reported over the last decade. Nevertheless, it is still considered one of the most important healthcare-associated cause of diarrhea worldwide. Several measures have been taken to reduce infections. Here we analyze the latest development of hospital coding for CDI in Germany to test, whether the descending trend still holds.

METHODS: Reports from the Institute for Hospital Remuneration Systems, German Federal Statistical Office (DESTATIS), during 2010–2023 were examined for CDI coding

RESULTS: Peaks of 32,203 cases with a primary diagnosis (PD) of CDI and 78,648 cases with a secondary diagnosis (SD) of CDI were observed in 2015. The number of cases decreased to 14,935 PD cases (‑53.6%) and 37,600 SD cases (-52.2%) by 2023, paralleled by a similar decline in notifiable severe cases. Sex distribution hardly shifted; in 2010, 61.0% of PD-coded patients (14,150) and 53.0% of those with SD (33,604) were female. By 2023 the proportion of females had reduced to 58.8% (-2.1%) of PD-coded patients and 51.4% (-1.6%) with SD. In 2015, average ages were 75.1 years for PD and 75.9 years for SD of CDI. In 2023, these decreased to 71.4 years and 72.0 years, for PD and SD respectively. For PD, the average length of hospital stay was 10.6 days in 2015 and 9.6 days (-9.5%) in 2023. In 2021, the in-hospital mortality rates of patients with SD and PD were 13.4% (5,383 of 40,118) and 5.7% (886 of 15,412), respectively.

CONCLUSIONS: Hospital coding of CDI and notification to authorities has more than halved from 2015 to 2023. Potential influential factors include hospital hygiene campaigns, implementation of antibiotic stewardship programs, and a decrease in more pathogenic subtypes of bacteria. Further research is necessary to validate the multiple possible drivers for this development.