Clostridioides difficile infection (CDI) is associated with a large burden on the healthcare system in the United States. Compared with patients without CDI, the mean difference in length of stay of patients with CDI infection varied from 3.0 to 21.6 days, and the burden on the healthcare system was calculated at 8.3 cases per 10,000 patient-days, according to results published in JAMA Network Open.1

CDI is the most common pathogen causing healthcare-associated infection in the United States, accounting for 15% of all such infections.2 Antibiotic resistance to CDI is becoming an urgent threat, according to the Centers for Disease Control and Prevention.3 In fact, antibiotic treatment for CDI is often followed by recurrent infection, leading to treatment with fecal transplant and oral administration of nontoxigenic C difficile spores.

To address gaps in the understanding of the current burden associated with CDI, researchers conducted a review and meta-analysis of databases that included the terms “Clostridioides difficile,” “length of stay,” and “incidence.”

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The reviewers obtained data on study design, study population, setting and years, inclusion and exclusion criteria, number of patients included, description of control group, definition of CDI, outcomes, and an assessment of the potential risk of bias.

A total of 66 articles evaluated incidence of CDI and 20 evaluated LOS. Thirteen of the 66 studies used patient-days as the denominator; the pooled incidence among hospital-acquired CDI among the 13 studies was 8.3 cases of CDI per 10,000 patient-days and varied greatly from 3.0 days to 10.3 days. Among the 3 pediatric propensity score-matched studies, the CDI-associated mean difference in LOS days was 21.6 days.

“Our systematic review of the literature found that CDI incidence varied by study and that the investigators used different denominators when they calculated the incidence for specific study populations,” the authors stated. “In our meta-analysis of studies that used patient-days as the denominator, we estimated the incidence of CDI in the United States to be 8.3 CDI cases per 10,000 patient-days.”

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The researchers cautioned that “these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions.” Understanding the burden of CDI infection will help researchers develop better ways to prevent and treat hospital-acquired infections, the researchers concluded.


1. Marra AR, Perencevich EN, Nelson RE, et al. Incidence and outcomes associated with Clostridium difficile infections: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(1):e1917597.

2. Magill  SS, O’Leary  E, Janelle  SJ,  et al. Emerging Infections Program Hospital Prevalence Survey Team.  Changes in prevalence of health care-associated infections in U.S. hospitals.  N Engl J Med. 2018;379(18):1732-1744.

3. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Published April 23, 2013. Accessed January 23, 2020.