New research presented at IDWeek 2025 shows a stark racial divide in deaths from Clostridioides difficile infection (CDI).
In a review of data from the US Centers for Disease Control and Prevention (CDC), a team led by researchers from AdventHealth Sebring in Florida found that White people accounted for 83.9% of the 216,311 reported US deaths associated with CDI from 1999 through 2023, while Black Americans accounted from 8.1% and Hispanic people 5.5%.
The percentage of those groups among the total US population, according to 2020 census data, is 57.8% White, 12.1% Black, and 18.7% Hispanic or Latino.
The data also showed notable geographic differences in CDI deaths, with 83.8% occurring in and around large urban areas and 16.2% in non-metropolitan areas. More than 70% of CDI deaths occurred in hospital inpatients, while 20% occurred in nursing home, long-term acute care, and hospice patients.
The study has not yet been published in a peer-reviewed scientific journal.
Surprising findings
CDI causes inflammation of the colon and severe diarrhea and is responsible for estimated 500,000 illnesses and 30,000 deaths in the United States each year.
Antibiotic use, which can disturb the balance of bacteria in the gut microbiome and enable the C difficile bacterium to flourish, is a primary risk factor. According to the CDC, people are 7 to 10 times more likely to get CDI while taking an antibiotic or during the following month
At an IDWeek press briefing, lead study author Muhammad Asghar, MBBS, MD, a resident physician at AdventHealth Sebring, said the findings were surprising, because healthcare-related infections typically have social determinants, and the people who get them—and die from them—tend to be from minority populations, have fewer resources, and have less access to healthcare.
"However, with C diff it's actually the opposite," Asghar said. "It's the White population. They have more resources, more access to healthcare utilization, and they are more prone to be exposed to antibiotics or all the other risk factors."
An uptick in C diff deaths from 2006 to 2015
Other notable trends were that CDI-associated deaths were higher in women than men (58.2% vs 41.9% in men) and that 33.0% of deaths occurred in the South census region, followed by 24.4% in the Midwest, 22.2% in the Northeast, and 20.3% in the West. Rhode Island has the highest crude mortality rate, at 6.55 per 100,000.
Asghar and his colleagues also noted a marked increase in CDI-associated deaths starting in 2006 and lasting until 2015. In 1999, he said, the CDI death rate was only 0.5 for every 100,000 patients. But in 2006 that number climbed 3.6 per 100,000 patients and stayed at that level through 2015. Asghar said that trend coincides with the arrival of hypervirulent strains of C difficile and rising resistance to standard CDI treatments. The trend was "especially profound" in White people, he said.
The good news is that the CDI death rate has fallen since 2015. Asghar said the decline, seen across all census regions, can be attributed in part to better treatment options, such as fidaxomicin and fecal microbiota transplantation. Fidaxomicin became the recommended first-line treatment for CDI in 2021 per guidelines from the Infectious Diseases Society of America (IDSA).
Asghar also said improved infection prevention and control and antimicrobial stewardship programs, which aim to reduce unnecessary antibiotic use, have played a critical role.
"The findings of this study underscore the importance of sustained preventive strategies to further reduce the burden of this infection," he said.
IDWeek is the joint annual meeting of IDSA, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.
