25 Years of Clostridioides difficile Deaths Reveal Who Is Most at Risk—and Where IPC Can Bend the Curve

Atlanta, Georgia, USA

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A quarter-century analysis presented at IDWeek 2025, held in Atlanta, Georgia, from October 19 to 22, 2025, puts fresh numbers and urgency behind the work infection preventionists (IPs) do every day. Reviewing 216,311 US deaths in which Clostridioides difficile (C difficile) was listed as a cause between 1999 and 2023, investigators found striking demographic and geographic patterns. White people accounted for 83.9% of C difficile–related deaths, compared with 8.1% among African American/Black people and 5.5% among Hispanic people. Women made up nearly three-fifths of deaths (58.2%). And location mattered: 83.8% of deaths occurred in or around large metropolitan areas.

Just as important for frontline infection prevention and control personnel is place of exposure. Most deaths were connected to health care settings: 71.2% inpatients, with another 21.2% across nursing or long-term care, outpatient or emergency departments, or hospice. Mortality peaked from 2006 to 2015 amid hypervirulent, antimicrobial-resistant strains, then declined after 2015, which the authors attribute in part to tighter prevention and stewardship guidance.

“C diff’s prevalence in health care settings flips the usual dynamics of privilege: Those who can afford more access to health care are more likely to die from infection,” said Muhammad Sohaib Asghar, MBBS, MD, resident physician at AdventHealth Sebring and presenting author. “The United States must double down on progress made in lowering C diff-related deaths by promoting responsible antibiotic use—particularly in health care settings—to address disparities.”

What This Means for IPC programs

These findings do not suggest that race or ethnicity biologically predispose people to C difficile; rather, they likely reflect differences in age structure, health care exposure, comorbidity burden, procedure intensity, and antibiotic use, all factors IPC can influence.

Why this matters now

C difficile remains one of the most preventable fatal infections in modern health care. The analysis presented at IDWeek shows that when exposure and antibiotic pressure concentrate in hospitals and large metro systems, deaths follow. The good news is the curve is already bending in the right direction—proof that IPC, environmental services, nursing, and stewardship teams can change outcomes at scale. The call to action from the authors is the same one IPC has championed for years: uncompromising basic practices, smarter antibiotics, and relentless measurement.

In addition to Asghar, study coauthors include Rupesh Andani, MBBS, MD; Maria Duharte, BS; Afsana Ansari Shaik, MBBS, MD; Shehar Bano, MBBS, MD; and Luis Duharte-Vidaurre, MD.