Clostridium difficile–associated Disease in the Elderly, United States.

The researchers assessed trends of Clostridium difficile–associated Disease (CDAD) in the elderly by using hospital billing data from the Centers for Medicare and Medicaid Services (CMS), which covers 98% of the elderly population. All hospitalisation records that included C. difficile were abstracted. There was an observed increase in overall hospitalisations that included a diagnosis for CDAD. The highest rate of hospitalisations was detected in the oldest patients (>85 years of age). There was also an observed increase in the percentage of patients with CDAD who died, from 8.8% in 1993 to 9.7% in 2004, which is an annual increase of 0.075% over the 12-year period. There was also an observed a peak in 2000; 10.4% of patients with CDAD died. This peak is unusual and unexplained and requires further analysis. There was an increasing trend and strong seasonal pattern in CDAD hospitalisations. This may be due to an increase in disease or may be caused by increased testing and recognition of disease. Increases may also be due to a reporting bias of gastroenteric diseases. To assess this possibility, all records that included other infectious gastroenteritis without CDAD were extracted and the trend was compared with CDAD hospitalisations. Rates for all other GI infections remained fairly constant over the study period, and a reporting bias for GI infections does not account for the ?3-fold increase in CDAD hospitalisations. The researcher’s conclusions support the observations of Zilberberg et al, 2008. and demonstrate the substantial increase in CDAD-related hospitalisations over time. These findings and the ageing population in the United States underscore the need for further research to understand all aspects of CDAD. Emerg Infect Dis. 2009;15(2):343-44.