Length of stay and hospital costs among high-risk patients with hospital-origin Clostridium difficile-associated diarrhea

Abstract

Objective:

Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD.

Research design and methods:

A retrospective analysis (2005–2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48 h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group.

Results:

A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI = 1.4–4.6) additional days in older patients to 7.8 (95% CI = 5.7–9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p < 0.001) and among those with renal impairment (p = 0.012) or CAbx use (p < 0.001).

Limitations:

Missing cost data and potential misclassification of colonized patients as infected.

Conclusions:

Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.

Keywords::

• Clostridium difficile
• Outcomes
• Cost
• Hospitalization

Transparency

Declaration of funding

This work was supported by Optimer Pharmaceuticals.

Declaration of financial/other relationships

RC, BD, and TH are employees of Cerner Corporation, which received payment for consulting services delivered to Optimer in connection with the conduct of this study and the development of this manuscript. MS and ST are employees of Optimer Pharmaceuticals. BN’s company, OptiStatim, LLC, was paid a consulting fee by the Cerner Corporation. RC, BD, and TH are stockholders and employees of Cerner Corporation, which owns the Health Facts database and provides consulting services to pharmaceutical and biotechnology companies, including Optimer.

Acknowledgments

No assistance in the preparation of this article is to be declared.