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Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

Published online by Cambridge University Press:  02 January 2015

Xiaoyan Song ,
John G Bartlett ,
Kathleen Speck ,
April Naegeli ,
Karen Carroll  and
Trish M. Perl
Xiaoyan Song*
Affiliation:
Johns Hopkins Medical Institutes, Baltimore, Maryland
John G Bartlett
Affiliation:
Johns Hopkins Medical Institutes, Baltimore, Maryland
Kathleen Speck
Affiliation:
Johns Hopkins Medical Institutes, Baltimore, Maryland
April Naegeli
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Karen Carroll
Affiliation:
Johns Hopkins Medical Institutes, Baltimore, Maryland
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutes, Baltimore, Maryland
*
The Children's National Medical Center, Suite W3.5-100, 111 Michigan Avenue, NW, Washington, DC 20010 (xsong@cnmc.org)
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Abstract

Background.

Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.

Objective.

To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.

Design.

A retrospective matched cohort study.

Patients.

Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.

Methods.

Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.

Results.

The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.

Conclusions.

There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 9 , September 2008 , pp. 823 - 828
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Kenneally, C, Rosini, JM, Skrupky, LP, et al.Analysis of 30-day mortality for Clostridium difficile-associated disease in the ICU setting. Chest 2007;132:418–424.Google Scholar
2.MacGowan, AP, Feeney, R, Brown, I, McCulloch, SY, Reeves, DS, Lovering, AM. Health care resource utilization and antimicrobial use in elderly patients with community-acquired lower respiratory tract infection who develop Clostridium difficile-associated diarrhoea. J Antimicrob Chemother 1997;39:537–541.CrossRefGoogle ScholarPubMed
3.Riley, TV. Antibiotic-associated diarrhoea. A costly problem. Pharmaco-economics 1996;10:1–3.CrossRefGoogle ScholarPubMed
4.Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:23–30.CrossRefGoogle ScholarPubMed
5.Spencer, RC. Clinical impact and associated costs of Clostridium difficile-associated disease. J Antimicrob Chemother 1998;41 Suppl C:5–12.CrossRefGoogle ScholarPubMed
6.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346–353.CrossRefGoogle ScholarPubMed
7.Kuijper, EJ, Coignard, B, Tiill, P, et al.Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 2006;12 Suppl 6:2–18.CrossRefGoogle ScholarPubMed
8.Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.Google Scholar
9.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.Google Scholar
10.Zafar, AB, Gaydos, LA, Furlong, WB, Nguyen, MH, Mennonne, PA. Effectiveness of infection control program in controlling nosocomial Clostridium difficile. Am J Infect Control 1998;26:588–593.Google Scholar
11.Oldfield EC 3rd. Clostridium difficile-associated diarrhea: risk factors, diagnostic methods, and treatment. Rev Gastroenterol Disord 2004;4:186–195.Google Scholar
12.Eckstein, BC, Adams, DA, Eckstein, EC, et al.Reduction of Clostridium difficile and vancomycin-resistant Enterococcus contamination of environmental surfaces after an intervention to improve cleaning methods. BMC Infect Dis 2007;7:61.CrossRefGoogle ScholarPubMed
13.Perencevich, EN, Stone, PW, Wright, SB, Carmeli, Y, Fisman, DN, Cosgrove, SE; Society for Healthcare Epidemiology of America. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007;28:1121–1133.CrossRefGoogle ScholarPubMed
14.Ticehurst, JR, Aird, DZ, Dam, LM, Borek, AP, Hargrove, JT, Carroll, KC. Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin. J Clin Microbiol 2006;44:1145–1149.Google Scholar
15.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK; Ad Hoc Clostridium difficile Surveillance Working Group. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
16.Charlson, ME, Sax, FL, MacKenzie, CR, Fields, SD, Braham, RL, Douglas, RG Jr. Resuscitation: how do we decide? A prospective study of physicians' preferences and the clinical course of hospitalized patients. JAMA 1986;255:1316–1322.CrossRefGoogle ScholarPubMed
17.Riley, TV, Codde, JP, Rouse, IL. Increased length of hospital stay due to Clostridium difficile associated diarrhoea. Lancet 1995;345:455–456.CrossRefGoogle ScholarPubMed
18.Ramaswamy, R, Grover, H, Corpuz, M, Daniels, P, Pitchumoni, CS. Prognostic criteria in Clostridium difficile colitis. Am J Gastroenterol 1996;91:460–464.Google Scholar
19.Sunenshine, RH, McDonald, LC. Clostridium difficile-associated disease: new challenges from an established pathogen. Cleve Clin J Med 2006;73:187–197.CrossRefGoogle ScholarPubMed