Epidemiology and Risk Factors of Clostridioides difficile Infections in Germany: A Health Claims Data Analysis

Abstract

Introduction Clostridioides difficile infection (CDI) is increasingly recognized as a public health threat at the community level in addition to being one of the most common causes of healthcare-associated infections. In Germany, the epidemiology of CDI is primarily informed by national hospital-based CDI surveillance. We used health claims data from Germany to obtain valuable insights on population-level disease burden and risk factors for CDI. Methods This was a retrospective cohort study using a representative sample from the InGef research database. Overall and age- and sex-stratified CDI incidence rates were estimated for German adults from 2013 to 2017 using different case definitions (i.e., main, broad, strict), and further stratified by setting (inpatient versus outpatient). Risk factors for CDI were assessed for the 2013–2016 period. Results The CDI incidence rate was high but declined by 15.3% from 2013 [141 (95% confidence interval, CI 137–145) cases/100,000 person-years] to 2017 [120 (95% CI 116–123)]. Annual CDI incidence rates were higher in female patients and the elderly. The most important risk factors for CDI were chronic inflammatory bowel disease [odds ratio (OR) 4.7, 95% CI 4.0–5.5], chemotherapy (OR 4.7, 95% CI 4.1–5.2), chronic kidney disease (OR 2.9, 95% CI 2.6–3.3), and ciprofloxacin receipt (OR 2.6, 95% CI 2.4–2.8). Conclusions Despite prevention strategies leading to declining incidence, CDI remains an important public health threat in Germany, with a high burden in the hospital setting and an outpatient epidemiology that is poorly understood. These findings, which are relevant both regionally and globally, can be used as a basis for further research on the full burden of CDI in Germany. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00800-6.

Epidemiological and clinical burden of Clostridioides difficile infections and recurrences between 2015 − 2019: the RECUR Germany study

“…However, the use of antibiotics is likely underestimated since hospital-dispensed treatments are not recorded in the BKK database. Like other studies, there was a higher proportion of female patients in our study [ 5 , 36 – 38 ]. So far, no association has however been found between gender and susceptibility to CDI.…”

Improving Clostridioides difficile Infectious Disease Treatment Response via Adherence to Clinical Practice Guidelines

“…Comorbidities are common among patients with CDID and are generally reported as not only a risk factor for this disease, but also for its complications and even reduction in survival [59][60][61][62]. Thus, we evaluated the influence of comorbidities in patients with concordant treatment, and our study revealed severe comorbidities to be significantly related to reduced 30-day survival and increased 30-day all-cause mortality, as well as to be a predictor for 30-day all-cause mortality.…”