Major Article
Burden of Clostridium difficile infection: Associated hospitalization in a cohort of middle-aged and older adults

https://doi.org/10.1016/j.ajic.2016.12.006Get rights and content

Highlights

  • CDI hospitalizations had longer hospital stay, greater costs, and higher proportion with in-hospital deaths compared to non-CDI hospitalization.

  • Of patients hospitalized with CDI, 7.3% died during hospitalization.

  • Digestive, cardiovascular, neoplastic and respiratory diseases constituted nearly half of principal diagnoses for which CDI was a secondary diagnosis.

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.

Section snippets

Study population and data sources

We used data from the Sax Institute's 45 and Up Study, a prospective cohort study of healthy aging involving 267,153 men and women aged 45 years and older from the general population of the Australian state of New South Wales (NSW) (2006 population, 6.8 million persons).6 Participants were randomly selected from the Medicare Australia database, which includes all citizens and permanent residents of Australia, and some temporary residents and refugees. Approximately 10% of the population of NSW

Results

There were 641 hospitalizations with CDI during the study period. The average age at hospitalization was 76.7 ± 11.2 years, and 45% of patients were men. There were 712,178 hospitalizations without CDI and the average age of these patients was 70.4 ± 11.4 years, 53% were men. Table 1 summarizes the demographic characteristics of patients hospitalized with and without CDI during the study period.

Of those patients hospitalized with CDI, 7.3% (47 out of 641) died during hospitalization. The

Discussion

CDI-associated hospitalizations are longer, more costly, and have a higher proportion of in-hospital deaths compared with hospitalizations without CDI in middle-aged and older Australians. Whereas this may not translate to a large total burden on the health care system because they constitute only a small proportion of total hospital admissions (12,683 cases of hospital-identified CDI in public hospitals in Australia during 2011-20123 and 0.2% of all public hospital admissions14), the burden on

Conclusions

We found that patients hospitalized with CDI have relatively lengthy hospital stays and high costs, and are more likely to die in hospital then those with non-CDI hospitalizations. The increased length of stay, costs, and in-hospital deaths associated with CDI are found across patients with a range of diagnoses. An appreciation of the burden of CDI hospitalization is important to ensure proper allocation of health care resources for CDI prevention and treatment efforts.

Acknowledgements

The authors thank the many thousands of people who participated in the 45 and Up Study.

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    In our study, CDI was associated with a twice-longer hospital stay and a twice-higher risk of in-hospital mortality and one-year mortality compared with AP patients without CDI. This heavy burden of CDI and higher mortality has been widely documented [31,33–35]. In a study by Becerra et al. on more than 500,000 patients in the USA, CDI tripled in-hospital mortality and doubled length of hospital stay after AP [15].

  • An evaluation of buffered peracetic acid as an alternative to chlorine and hydrogen peroxide based disinfectants

    2019, Infection, Disease and Health
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    Label claims against specific organisms are required to match scientific data provided to the Therapeutic Goods Administration (TGA) prior to registration. The mortality risk for C. difficile infections (CDI) is estimated at 7.3% of CDI patients admitted into Australian healthcare facilities [7]. The significance of C. difficile and other pathogen contamination of floor surfaces and the ability of transference through floor contact has been previously reported [8].

  • Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology

    2018, Journal of Hospital Infection
    Citation Excerpt :

    The main characteristics of the studies included and the statistical methods identified are shown in Table I. There were: 23 studies [26,30–51] with an estimate of impact of BSI on LOS; 22 studies [50,52–72] with estimates from the impact of GI; 27 studies [37,42,43,47,50,73–94] with estimates from surgical site infection (SSI); 26 studies [4,43,47,50,79,80,85,95–113] with an average estimate from all types of HCAI; ten studies [35,37,42,43,45,47,50,80,114,115] with estimates from urinary tract infection (UTI); eight studies [35,37,42,47,114,116–118] with estimates from pneumonia; four studies [43,50,80,99] with estimates from lower respiratory tract infection (other than pneumonia); and one study [119] of bone and joint infection. In total we extracted 121 LOS estimates shown in Appendix D from 92 studies.

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YC received the 2014 Prime Minister's Australia Asia Postgraduate Scholarship from the Australian Government Department of Education and Training (No. 3929_2014), and a Higher Degree Research Tuition Fee Scholarship from the Australian National University. BL is funded by an Australian National Health & Medical Research Council Career Development Fellowship.

This research was completed using data collected through the 45 and Up Study (www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW and partners, including the National Heart Foundation of Australia (New South Wales Division); New South Wales Ministry of Health; New South Wales Government Family & Community Services—Careers, Ageing, and Disability Inclusion; and the Australian Red Cross Blood Service.

Conflicts of interest: None to report.

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