title: The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study.
abstract: OBJECTIVE
  To assess the impact of Clostridium difficile infection (CDI) on hospital resources and costs in Spain and Italy.
  
  
  METHODS
  CDI data were collected from institutions in Spain and Italy. Each patient was matched with two randomly selected uninfected controls in the same institution. Patient outcomes were assessed for the first and second episodes of CDI and for patients aged ≤65 and >65 years. The impact of CDI on hospital length of stay (LOS) was used to calculate CDI-attributable costs. A multivariate analysis using duration of stay as the continuous outcome variable assessed the independent effect of CDI on hospital costs and LOS.
  
  
  RESULTS
  LOS attributable to CDI ranged from 7.6-19.0 days in adults and was 5.0 days in children; the increases were greater in adults in Italy than in Spain. Attributable costs per adult patient ranged from €4396 in Madrid to €14 023 in Rome, with the majority of the cost being due to hospitalization. For children, the total attributable cost was €3545/patient.
  
  
  CONCLUSIONS
  These data show that the burden of CDI is considerable in Spain and Italy. Treatments that can reduce LOS, disease severity, and recurrence rates, as well as effective infection control measures to prevent transmission, have the potential to reduce the burden of CDI.
authors.affiliation: Hospital Universitario Puerta de Hierro, C/ Manuel de Falla 1, Majadahonda 28222, Madrid, Spain; University Francisco de Vitoria, Madrid, Spain. Electronic address: aasensiov@salud.madrid.org.
authors.forename: Angel
authors.initials: A
authors.lastname: Asensio
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Bella
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.affiliation: Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.affiliation: EcoStat Consulting UK Ltd, London, UK.
authors.forename: Warren M
authors.initials: WM
authors.lastname: Hart
authors.affiliation: HM Hospitales, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Isidoro
authors.affiliation: Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Scotto
authors.affiliation: National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Astellas Pharma EMEA, Chertsey, UK.
authors.forename: Maureen
authors.initials: M
authors.lastname: Watt
authors.affiliation: Astellas Pharma EMEA, Chertsey, UK.
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000191:economics* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006295:Health Resources; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013030:Spain; D055815:Young Adult
keywords: CDI; Clostridium difficile infection; Cost burden; Hospital length of stay; Matched cohort analysis