title: Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital.
abstract: OBJECTIVE
  Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown.
  
  
  METHODS
  We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDAD patients without recurrence), recurrence group (CDAD patients with ≥1 recurrence) and control group (matched non-CDAD patients).
  
  
  RESULTS
  Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30-37), 94 (95 %CI: 76-112) and 24 days (95 %CI: 22-27; P = <0.001), resulting in mean overall direct treatment costs per patient of €18,460 (95 %CI: €14,660-€22,270), €73,900 (95 %CI: €50,340-€97,460) and €14,530 (95 %CI: €11,730-€17,330; P = <0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10-12) and 36 (95 %CI: 27-45; P = <0.001).
  
  
  CONCLUSIONS
  Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. sebastian.heimann@uk-koeln.de.
authors.forename: S M
authors.initials: SM
authors.lastname: Heimann
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
authors.forename: J J
authors.initials: JJ
authors.lastname: Vehreschild
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.|Clinical Trials Centre Cologne, ZKS Köln, BMBF01KN1106, and Cluster of Excellence, Cellular Stress Responses in Aging-Associated Diseases, CECAD, University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany.|Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany.
authors.forename: O A
authors.initials: OA
authors.lastname: Cornely
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Wisplinghoff
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hallek
authors.affiliation: Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany.|Department of Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Goldbrunner
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: B W
authors.initials: BW
authors.lastname: Böttiger
authors.affiliation: Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany.|Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Goeser
authors.affiliation: Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany.|Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hölscher
authors.affiliation: Department of Cardiology, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Müller
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Jazmati
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wingen
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Franke
authors.affiliation: Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. maria.vehreschild@uk-koeln.de.|German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany. maria.vehreschild@uk-koeln.de.
authors.forename: M J G T
authors.initials: MJ
authors.lastname: Vehreschild
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D017281:Cost of Illness; D003967:Diarrhea / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Antibiotic treatment; Clostridium difficile associated diarrhoea recurrence; Direct costs; Indirect costs; Societal burden