Deaths from C. difficile higher in women, White patients

Despite advances in infection control and antimicrobial stewardship, mortality from Clostridioides difficile (C. difficile) enterocolitis continues to disproportionately affect certain populations in the US, according to an analysis of the CDC WONDER database presented at IDWeek 2025.

Although overall mortality has improved, vulnerable populations continue to face increased risks. Out of more than 216,000 deaths caused by C. difficile, 58.1 percent occurred among women. White patients accounted for the majority of deaths (83.9 percent), compared with Black and Hispanic patients (8.1 percent and 5.5 percent, respectively).

Most fatalities occurred in large urban areas, which accounted for 83.8 percent, with the more populous South reporting the highest regional burden.

Disparities require targeted interventions

The study highlights persistent disparities by gender, race, and geography, underscoring the importance of targeted public health interventions. “Clinicians should be aware of these patterns when assessing risk and advocating for infection prevention strategies, especially in high-burden regions and care settings,” said the researchers.

They analysed 216,311 deaths attributed to C. difficile enterocolitis between 1999 and 2023 using the CDC WONDER public health database. Mortality peaked in the early 2000s, driven by hypervirulent strains and increasing antibiotic resistance, but declined steadily since 2016. [IDWeek 2025, abstract 193]

Most deaths occurred in inpatients (71.2 percent), while 15 percent occurred in nursing homes or long-term acute care, and 4.6 percent in hospice facilities. Only 5.5 percent of deaths occurred in patient homes.

 Population at risk

Study author Dr Muhammad Sohaib Asghar, a resident physician at AdventHealth Sebring in Sebring, Florida, US, said what they found most striking was the group at highest risk.

“Traditionally, we believe that infections, especially healthcare-associated infections or wild infections like HIV and hepatitis, are influenced by social factors. We assume that people who are infected or die from these diseases tend to come from low socioeconomic backgrounds or have limited access to healthcare,” he said.

“However, with C. diff, it’s actually the opposite,” Asghar added. “It’s the White population. They have more resources, better access to healthcare, and are more likely to be exposed to antibiotics or other risk factors,” such as being in a nursing home.

Additionally, when deaths were evaluated by region, the largest proportion was in the South at 33.1 percent, followed by 24.4 percent in the Midwest, 22.2 percent in the Northeast, and 20.3 percent in the West.

However, after adjusting for age, mortality trends were highest in the Northeast. The states with the highest crude mortality rates, ranging from 4.1 to 6.6 per 100,000 people, included Missouri, West Virginia, Vermont, Ohio, Maine, and Rhode Island. Conversely, the states with the lowest mortality rates, from 0.77 to 1.6 per 100,000 people, were Hawaii, Alaska, Utah, Louisiana, Mississippi, and Georgia.

Asghar said irrational use of antibiotics is one of the main risk factors linked to C. difficile infection. In fact, in a separate study presented at IDWeek 2025, prolonged exposure to high-risk antibiotics was associated with progression from C. difficile colonization to infection. [IDWeek 2025, abstract 189]

The findings reinforce the need for vigilant antimicrobial stewardship across the continuum of care, especially in high-risk populations.