title: Rising economic impact of clostridium difficile-associated disease in adult hospitalized patient population.
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.
  
  
  METHODS
  A retrospective matched cohort study.
  
  
  METHODS
  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 1 or 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.
authors.affiliation: Johns Hopkins Medical Institutes, Baltimore, Maryland, USA. xsong@cnmc.org
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Song
authors.forename: John G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: Kathleen
authors.initials: K
authors.lastname: Speck
authors.forename: April
authors.initials: A
authors.lastname: Naegeli
authors.forename: Karen
authors.initials: K
authors.lastname: Carroll
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification; D015331:Cohort Studies; D004761:Enterocolitis, Pseudomembranous / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged