Increasing burden of Clostridioides difficile infection in Spain: nationwide trends in hospitalisations, 2016-2023

Clostridioides difficile infection (CDI) is a major cause of morbidity and mortality worldwide. In Spain, the epidemiology of Clostridioides difficile infection remains insufficiently characterised due to the limited availability of epidemiological data.

To provide a comprehensive national description of the incidence, temporal trends and epidemiological characteristics of CDI in Spain from 2016 to 2023.

A nationwide retrospective observational study was conducted, using the Spanish Hospital Discharge Database (RAE-CMBD). Annual incidence rates were calculated per 10,000 hospital admissions at national and autonomous community (AC) levels, by sex and age group. Temporal trends were assessed using Kendall's tau. CDI cases were classified according to timing of onset as present on admission or hospital-onset.

A total of 81,487 CDI -related hospitalisations were identified. National incidence increased steadily from 15.6 to 31.4 cases per 10,000 admissions between 2016 and 2023, showing a significant upward trend. The highest burden was observed among patients aged ≥ 75 years. Overall, 72% of CDI cases were present at hospital admission, while 28% were hospital-onset. Hospital-onset CDI was associated with higher in-hospital mortality compared with cases present on admission (13.8% vs 10.7%).

The incidence of Clostridioides difficile infection diagnosed in Spanish hospitals showed a substantial increase over the study period. Despite the study's limitations, these results reinforce the importance of antimicrobial stewardship and infection prevention programmes across all levels of healthcare settings to reduce the impact of CDI.