title: Burden of Clostridium difficile infection: Associated hospitalization in a cohort of middle-aged and older adults.
abstract: BACKGROUND
  Clostridium difficile is the principal cause of infectious diarrhea in hospitalized patients. The aim of this study was to describe and compare length of stay (LOS), costs, and in-hospital deaths for C difficile infection (CDI) and non-CDI hospitalizations, in a cohort of middle-aged and older Australians.
  
  
  METHODS
  We used survey data from the 45 and Up Study, linked to hospitalization and death data. We calculated the average LOS and costs per hospitalization, and the proportion of in-hospital deaths for CDI and non-CDI hospitalizations. We then compared hospitalizations with CDI as a secondary diagnosis to non-CDI hospitalizations by stratifying hospitalizations based on principal diagnosis and then using generalized linear models to compare LOS and in-hospital costs, and logistic regression for in-hospital deaths, adjusting for age and sex.
  
  
  RESULTS
  There were 641 CDI hospitalizations during 2006-2012. The average LOS was 17 days; the average cost per hospitalization was AUD 12,704; and in 7.3% of admissions (47 out of 641) the patient died. After adjusting for age and sex, hospitalizations with CDI were associated with longer LOS, higher costs, and a greater proportion of in-hospital deaths compared with hospitalizations with similar principal diagnosis but without CDI.
  
  
  CONCLUSIONS
  CDI places additional burden on the Australian hospital system, with CDI patients having relatively lengthy hospital stays and high costs.
authors.affiliation: Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Yingxi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Glass
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Bette
authors.initials: B
authors.lastname: Liu
authors.affiliation: Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Korda
authors.affiliation: Microbiology and Immunology, University of Western Australia, Nedlands, Australia; Department of Microbiology Path West Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Riley
authors.affiliation: Research School of Population Health, Australian National University, Canberra, Australia. Electronic address: martyn.kirk@anu.edu.au.
authors.forename: Martyn D
authors.initials: MD
authors.lastname: Kirk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis
keywords: CDI; Cost; In-hospital death; Length of stay