S2152 The Burden of Clostridioides difficile Infection in the United States: Temporal Analysis of the Past 3 Decades

Introduction: Clostridiodies difficile infection (CDI) is the leading etiology of nosocomial diarrheal illnesses. It imposes a significant burden due to the associated morbidity and mortality. Accordingly, evaluating the temporal trends in CDI-associated mortality and disability-adjusted life year (DALY) in the United States is of vital importance in order to enable risk stratification and implement preventative measures to tackle the associated burden. Methods: Temporal trends in the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of CDI in the U.S. were evaluated by retrieving data from the Global Burden of Disease database for the period 1990-2021. Joinpoint analysis was performed to calculate the annual percent change (APC) and the average annual percent change (AAPC). Stratification by gender and state was done to evaluate for any disparities between genders and states, respectively. Results: Over the period 1990-2021, an estimated total of 143,339 CDI-related deaths with a 59.1% female predominance were reported in the U.S. A statistically significant increase in CDI ASMR was observed across the U.S. with an AAPC of 6.26 (95% confidence interval [CI] 6.07 to 6.43, P< 0.001). Stratification by gender revealed statistically significant increase in the ASMR in both men and women, with the latter experiencing a higher increase (AAPC 7.51, 95% CI 5.50 to 9.59, P< 0.001). Stratification by states revealed a statistically significant incline in the ASMR across all states, with the highest increase noted in Florida (AAPC 7.15, 95% CI 6.91 to 7.39, P< 0.001), followed by Tennessee (AAPC 6.81, 95% CI 6.61 to 7.00, P< 0.001) and California (AAPC 6.81, 95% CI 6.60 to 7.00, P< 0.001). In regard to the ASDR, a statistically significant increase was observed across the U.S. with an AAPC of 5.53 (95% CI 5.34 to 5.71, P< 0.001). Gender stratification also revealed a statistically significant in the ASDR in both men and women, with the latter experiencing a higher incline (AAPC 6.59, 95% CI 6.42 to 6.74, P< 0.001). On a state level, a statistically significant incline in the ASDR was observed across all states, with the highest increase noted in West Virgina (AAPC 6.21, 95% CI 6.02 to 6.37, P< 0.001), followed by Tennessee (AAPC 6.14, 95% CI 5.94 to 6.30, P< 0.001). Conclusion: Over the past 3 decades, the US experienced a significant increase in CDI-related burden, thus mandating a prompt recognition of these findings and intervention.