Increasing burden of Clostridioides difficile-related hospitalizations in Spain: A 26-year nationwide study...

To analyze crude and age-standardized hospitalization rates (ASRs) for Clostridioides difficile infection (CDI), temporal trends, and annual percentage change (APC) stratified by sex.

Hospital admissions with a primary diagnosis of CDI were included (ICD-9 code 008.45 for 1997-2015 and ICD-10 code A04.7x for 2016-2022), obtained from the Spanish National Hospital Data Surveillance System. Population data were sourced from the Spanish National Statistics Institute. ASR per 100,000 inhabitants were calculated using the 2022 population as the reference. Temporal trends by age and sex were analyzed using joinpoint regression (JPR), which estimates APC and assesses the statistical significance of each trend segment.

A total of 119,682 hospitalizations were identified (56,864 men and 62,818 women). Annual admissions increased from 286 (men) and 280 (women) in 1997-6316 and 7140 in 2022, respectively. Crude and ASR rose from 1.46 and 2.23 per 100,000 in men and 1.37 and 1.71 per 100,000 in women in 1997, to 26.27 in men and 29.38 in women in 2022. JPR analysis revealed distinct sex-specific trends: among women, the increase was gradual and statistically significant (APC = 9.99, p < 0.05), whereas in men, three significant joinpoints were identified: 1997-2002 (APC = 20.48), 2002-2015 (APC = 18.2), and 2015-2022 (APC = 6.61).

Hospitalizations due to CDI in Spain have increased markedly and progressively over the past 26 years. The rise was gradual and continuous among women, whereas men experienced three distinct periods of significant growth. These findings highlight CDI as a major public health concern and support the need for further optimization of clinical and infection prevention and control strategies.