Shrestha Manish P, Bime Christian, Taleban Sasha
Department of Medicine, University of Arizona College of Medicine, Tucson.
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, University of Arizona College of Medicine, Tucson.
Am J Med. 2018 Jan;131(1):90-96. doi: 10.1016/j.amjmed.2017.07.022. Epub 2017 Aug 8.
Clostridium difficile infection has emerged as a major public health problem in the United States over the last 2 decades. We examined the trends in the C. difficile-associated fatality rate, hospital length of stay, and hospital charges over the last decade.
We used data from the National Inpatient Sample to identify patients with a principal diagnosis of C. difficile infection from 2004 to 2014. Outcomes included in-hospital fatality rate, hospital length of stay, and hospital charges. For each outcome, trends were also stratified by age categories because the risk of infection and associated mortality increases with age.
Clostridium difficile infection discharges increased from 19.9 per 100,000 persons in 2004 to 33.8 per 100,000 persons in 2014. Clostridium difficile-associated fatality decreased from 3.6% in 2004 to 1.6% in 2014 (P < .001). Among patients aged 45-64 years, fatality decreased from 1.2% in 2004 to 0.7% in 2014 (P < .001). Among patients aged 65-84 years, fatality decreased from 4.3% in 2004 to 2.0% in 2014 (P < .001). Among patients aged ≥85 years, fatality decreased from 6.9% in 2004 to 3.6% in 2014 (P < .001). The mean length of hospital stay decreased from 6.9 days in 2004 to 5.8 days in 2014 (P < .001). The mean hospital charges increased from 2004 ($24,535) to 2014 ($35,898) (P < .001).
In-hospital fatality associated with C. difficile infection in the United States has decreased more than 2-fold in the last decade, despite increasing infection rates.
在过去20年里，艰难梭菌感染已成为美国一个主要的公共卫生问题。我们研究了过去十年中艰难梭菌相关死亡率、住院时间和住院费用的趋势。
我们使用来自全国住院患者样本的数据，以确定2004年至2014年主要诊断为艰难梭菌感染的患者。结果包括院内死亡率、住院时间和住院费用。对于每个结果，趋势也按年龄类别进行分层，因为感染风险和相关死亡率会随着年龄增长而增加。
艰难梭菌感染出院率从2004年的每10万人19.9例增至2014年的每10万人33.8例。艰难梭菌相关死亡率从2004年的3.6%降至2014年的1.6%（P <.001）。在45 - 64岁的患者中，死亡率从2004年的1.2%降至2014年的0.7%（P <.001）。在65 - 84岁的患者中，死亡率从2004年的4.3%降至2014年的2.0%（P <.001）。在年龄≥85岁的患者中，死亡率从2004年的6.9%降至2014年的3.6%（P <.001）。平均住院时间从2004年的6.9天降至2014年的5.8天（P <.001）。平均住院费用从2004年的24,535美元增至2014年的35,898美元（P <.001）。
在美国，尽管感染率上升，但过去十年中与艰难梭菌感染相关的院内死亡率下降了两倍多。
