Objectives
Clostridium difficile infection is a common hospital-acquired infection resulting in increased length of stay and excess health care costs. Since 2006, C. difficile has been increasing in non-traditional populations including pregnant and peripartum women. The objective of this study is to determine the prevalence and risk factors for acquisition of C. difficile in peripartum women.
Methods
The Nationwide Inpatient Sample was queried for delivery and postpartum discharges from 2008-2010. Women with and without the International Classification of Diseases, 9th revision, Clinical Modifications code for C. difficile were identified for comparison. Bivariable and multivariable logistic regression modeling were used to evaluate the association of sociodemographic characteristics, maternal medical risk factors, and obstetric complications with the diagnosis of C. difficile. The prevalence of C. difficile in delivered and postpartum women was determined for 2000-2010.
Methods
The Nationwide Inpatient Sample was queried for delivery and postpartum discharges from 2008-2010. Women with and without the International Classification of Diseases, 9th revision, Clinical Modifications code for C. difficile were identified for comparison. Bivariable and multivariable logistic regression modeling were used to evaluate the association of sociodemographic characteristics, maternal medical risk factors, and obstetric complications with the diagnosis of C. difficile. The prevalence of C. difficile in delivered and postpartum women was determined for 2000-2010.
Results
From 2000 to 2010, there was a significant increase in the prevalence of C. difficile in peripartum women from 11.6 to 13.5 cases per 100,000 women. Out of approximately 12.6 million delivery and postpartum hospital discharges from 2008-2010, there were 1093 women diagnosed with C. difficile at delivery and 474 women diagnosed at a postpartum discharge. Women with C. difficile were older, had longer length of stay, and higher hospital costs (p<0.001). Women with obstetric complications including cesarean delivery (OR 3.01, 95% CI 2.67, 3.40), chorioamnionitis (OR 1.71, 95% CI 1.28, 2.29), preterm labor (OR 5.13, 95% CI 4.51, 5.83), and endometritis (OR 19.16, 95% CI 16.56, 22.17) had an increased risk of being diagnosed with C. difficile. After controlling for confounding variables, C. difficile infection continued to be associated with severe hospital morbidity in delivered and postpartum patients (Table 1).
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