Increased Number of Deaths with Concomitant Diagnosis of Clostridium Difficile in a Community Hospital

BACKGROUND/OBJECTIVES: Clostridium difficile colitis is an important cause of morbidity and mortality in hospitalized patients. Because of a concern about increasing lethality we reviewed deaths associated with Clostridium difficile in a community hospital setting. METHODS: All patient deaths for 2002, 2003, and 2004 were reviewed for a primary or concomitant diagnosis of Clostridium difficile. A comparison between the number of deaths for each of the 3 years relative to the total number of deaths in each of those years was made. The prevalence of Clostridium difficile for each year was determined and the relative risk (RR) for death associated with Clostridium difficile was calculated. RESULTS: For 2002 and 2003. 4.0% and 5.7%. of all deaths respectively were associated with Clostridium difficile infection. The difference between 2002-2003 and 2004 was highly significant with p > .001. However, the prevalence of Clostridium difficile increased from .68% of hospital discharges to 1.18%. The RR for death associated with Clostridium difficile in 2004 compared to 2002-2003 was 1.3 (95% CI=.91-1.8). Clostridium difficile Associated Deaths Clostridium difficile Infection Rates Per 100 Discharges Nosocomial vs Community Acquired CONCLUSIONS: Clostridium difficile associated mortality has increased significantly. Although the RR of death associated with Clostridium difficile was > 1, statistical significance was not acheived. The higher death rate may reflect a combination of increased case load and greater virulence. Further study is clearly warranted. Enhanced attention to judicious antibiotic use in susceptable patients is imperative to reduce the frequency of this lethal illness.