Clostridioides difficile

C. difficile Infection Rates May Vary With Diagnostic Techniques Interview with:

Alexandre R. Marra, MD PhD Iowa Infection Prevention Research Group University of Iowa Carver College of Medicine

Dr. Marra

Alexandre R. Marra, MD PhD
Iowa Infection Prevention Research Group
University of Iowa Carver College of Medicine
Division of Medical Practice, Hospital Israelita Albert Einstein
São Paulo, Brazil What is the background for this study?

Response: This is a comprehensive systematic literature review evaluating the burden of C. difficile infections in the U.S healthcare system. The literature has diverse studies with variable outcomes. Thus, we only included incidence estimates derived from multicenter studies. In our meta-analysis to calculate incidence, data were pooled only with denominators using the same unit (patient-days) to avoid comparisons with different denominators. For length of stay (LOS), we only included studies that used advanced statistical methods (e.g., propensity score matching). What are the main findings?

Response: Our main finding was that the the incidence of C. difficile in the U.S. is approximately 8.3 CDI cases per 10,000 patient-days. We also found that the excess hospital length of stay associated with CDI ranged from 3 to 21 days. What should readers take away from your report?

Response: The readers should take away that there is considerable variability among hospitals and studies in the C. difficile incidence rates and attributable length of stay. Another take home message is CDI definition is not only problematic but also complex, and variation in CDI incidence may be in part to advances in diagnostic technology as well as variations in diagnostic practices among different U.S institutions. What recommendations do you have for future research as a result of this work?

Response: An understanding of the incidence and impact of C. difficile infections (CDI) in the U.S. can inform investments in prevention and treatment interventions. Is there anything else you would like to add?

Response: Another strength of this study is that it excluded single-center studies that might be published in responses to a local outbreak. Thus, our systematic literature review and meta-analysis quantified the burden of C. difficile infections in the U.S., without overestimating the burden as has been done in past studies that used inferior methods.


Marra AR, Perencevich EN, Nelson RE, Samore M, Khader K, Chiang HY, Chorazy ML, Herwaldt LA, Diekema DJ, Kuxhausen MF, Blevins A,  Ward MA, McDanel JS, Nair R, Balkenende E, Schweizer ML. Incidence and outcomes associated with Clostridium difficile infections: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(1):e1917597. doi:10.1001/jamanetworkopen.2019.17597


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Last Updated on January 8, 2020 by Marie Benz MD FAAD