Abstract: SA-PO0358
Rates of Clostridioides difficile Infection Among Persons on Maintenance Hemodialysis in the Community and Hospital Settings: A Nationwide Analysis, 2018-2021
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Raker, Christina A., Rhode Island Hospital, Providence, Rhode Island, United States
- D'Agata, Erika M.C., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality. Persons on maintenance hemodialysis (pMHD) are at high risk of CDI due to frequent antibiotic and hospital exposure. Despite this heightened risk, comprehensive assessments of CDI epidemiology among pMHD remain limited.
Methods
We conducted a retrospective study of CDI rates among pMHD with Medicare Primary Payer in the United States Renal Data System from 2018-2021. New CDI cases were identified using ICD-10 diagnostic code A04.72. The Present on Admission (POA) indicator was used to determine if the CDI was present on hospital admission. CDI cases were classified as follows: 1] community-acquired (CA): out-patient claim or, in-patient claim but POA present, and no hospitalizations in the prior 12 weeks, 2] Community onset-hospital-associated (CO-HA): as CA but hospitalizations in previous 12 weeks, 3] Hospital-acquired (HA): in-patient claim with POA not present and 4] Hospital-associated (H-asso): HAI and CO-HA combined. Rates were calculated per 100,000 adults, and trends were assessed using linear regression. Rates of CDI among pMHD in 2021 were compared to the rates in the general population published by the Centers for Disease Control and Prevention for the same year.
Results
Among 526,888 pMHD included in the analysis, we identified 29,553 CDI cases over the study period. CDI rates ranged from 1,685 to 2,887 per 10^5 and decreased significantly over the study period (p<0.001). Similar declines were observed for CA, CO-HA, HA and H-asso CDI (Table). Rates of any CDI among pMHD were 15-fold higher than 2021 CDC data in the general population (1,685 per 10^5 vs 110 per 10^5, respectively), Similar higher rates among CA and H-asso CDI were observed among pMHD compared to CDC data.
Conclusion
Although CDI are declining among pMHD, rates are still substantially higher than the general population. Ongoing efforts towards improving infection prevention practices, antibiotic stewardship, and changes in healthcare delivery patterns are needed.
Funding
- Other U.S. Government Support