Length of stay and hospital costs among high-risk patients with hospital-origin Clostridium difficile-associated diarrhea.
OBJECTIVE
Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD.


METHODS
A retrospective analysis (2005-2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group.


RESULTS
A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4-4.6) additional days in older patients to 7.8 (95% CI = 5.7-9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001).


CONCLUSIONS
Missing cost data and potential misclassification of colonized patients as infected.


CONCLUSIONS
Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.
Cerner Research, Kansas City, MO, USA. becky.campbell@cerner.com
Rebecca
R
Campbell
Bonnie
B
Dean
Brian
B
Nathanson
Tracy
T
Haidar
Marcie
M
Strauss
Sheila
S
Thomas
D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016208:Databases, Factual; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology