title: Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study.
abstract: BACKGROUND
  Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI).
  
  
  OBJECTIVE
  To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI.
  
  
  METHODS
  This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode.
  
  
  RESULTS
  In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (P<0.0001, each). Total hospital median LOS and costs increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (P<0.0001, each). The median cost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013).
  
  
  CONCLUSIONS
  This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI.
authors.affiliation: Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA.
authors.forename: D N
authors.initials: DN
authors.lastname: Shah
authors.affiliation: Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Aitken
authors.affiliation: Internal Medicine Service, Baylor St Luke's Medical Center, Houston, TX, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: Barragan
authors.affiliation: Internal Medicine Service, Baylor St Luke's Medical Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bozorgui
authors.affiliation: Internal Medicine Service, Baylor St Luke's Medical Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Goddu
authors.affiliation: Internal Medicine Service, Baylor St Luke's Medical Center, Houston, TX, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Navarro
authors.affiliation: Department of Outcomes Research, Merck & Co., Whitehouse Station, NJ, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA; Internal Medicine Service, Baylor St Luke's Medical Center, Houston, TX, USA; Division of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA; Center for Infectious Diseases, University of Texas School of Public Health, Houston, TX, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: DuPont
authors.affiliation: Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA; Center for Infectious Diseases, University of Texas School of Public Health, Houston, TX, USA. Electronic address: kgarey@uh.edu.
authors.forename: K W
authors.initials: KW
authors.lastname: Garey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology; D003967:Diarrhea / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006268:Health Facilities; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult
keywords: Epidemiology; Financial analysis; Healthcare-associated infections; Outcomes research; Prospective study