title: Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.
abstract: BACKGROUND
  The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied.
  
  
  OBJECTIVE
  The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals.
  
  
  METHODS
  A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used.
  
  
  RESULTS
  A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences.
  
  
  CONCLUSIONS
  The economic burden of CDI is substantial and directly impacts healthcare systems in France.
authors.affiliation: Laboratoire de Microbiologie Clinique, GH Paris Saint-Joseph, Paris, France. Electronic address: alemonnier@hpsj.fr.
authors.forename: A
authors.initials: A
authors.lastname: Le Monnier
authors.affiliation: CEMKA-EVAL, Bourg la Reine, France.
authors.forename: A
authors.initials: A
authors.lastname: Duburcq
authors.affiliation: Laboratoire de Microbiologie-Hygiène, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants malades, AP-HP, Paris, France.
authors.forename: J-R
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Service de Bactériologie-Hygiène hospitalière, CHU de Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Corvec
authors.affiliation: Laboratoire de bactériologie-virologie-hygiène hospitalière, CHU de Reims, Hôpital Robert Debré, Université de Reims Champagne Ardenne, France.
authors.forename: T
authors.initials: T
authors.lastname: Guillard
authors.affiliation: Service de Microbiologie, CHU de Caen, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
authors.affiliation: Laboratoire de Microbiologie, Institut Gustave Roussy, Villejuif, France.
authors.forename: P-L
authors.initials: PL
authors.lastname: Woerther
authors.affiliation: Unité de Bactériologie-Hygiène, CHU Henri-Mondor, AP-HP, Créteil, France.
authors.forename: V
authors.initials: V
authors.lastname: Fihman
authors.affiliation: Département de Bactériologie, Hôpitaux Universitaires Est Parisien, Hôpital Saint-Antoine, AP-HP, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Lalande
authors.affiliation: Laboratoire de Microbiologie, Groupe Hospitalier Lariboisière Fernand Widal, AP-HP, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Jacquier
authors.affiliation: Laboratoire de Microbiologie Clinique, GH Paris Saint-Joseph, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Mizrahi
authors.affiliation: Laboratoire de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
authors.forename: E
authors.initials: E
authors.lastname: Farfour
authors.affiliation: Service de Bactériologie, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Morand
authors.affiliation: Service de Microbiologie-Hygiène, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Louis Mourier, AP-HP, Colombes, France.
authors.forename: G
authors.initials: G
authors.lastname: Marcadé
authors.affiliation: CEMKA-EVAL, Bourg la Reine, France.
authors.forename: S
authors.initials: S
authors.lastname: Coulomb
authors.affiliation: CEMKA-EVAL, Bourg la Reine, France.
authors.forename: E
authors.initials: E
authors.lastname: Torreton
authors.affiliation: CEMKA-EVAL, Bourg la Reine, France.
authors.forename: F
authors.initials: F
authors.lastname: Fagnani
authors.affiliation: Laboratoire Clostridium difficile associé au CNR des bactéries anaérobies, CHU Saint-Antoine, France.
authors.forename: F
authors.initials: F
authors.lastname: Barbut
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; D003967:Diarrhea / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Case–control study; Clostridium difficile infection; Costs analysis; Recurrence