Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile.

A total of 271 patients were prospectively followed up to determine whether patients whose hospital stay is complicated by diarrhea due to Clostridium difficile experience differences in cost and length of stay and survival rates when compared with patients whose stay is not complicated by C. difficile-associated diarrhea. Forty patients (15%) developed nosocomial C. difficile-associated diarrhea. These patients incurred adjusted hospital costs of $3669--that is, 54% (95% confidence interval [CI], 17%-103%)--higher than patients whose course was not complicated by C. difficile-associated diarrhea. The extra length of stay attributable to C. difficile-associated diarrhea was 3.6 days (95% CI, 1.5-6.2). C. difficile-associated diarrhea was not associated with excess 3-month or 1-year mortality after adjustment for age, comorbidity, and disease severity. On the basis of the findings of this study, a conservative estimate of the cost of this disease in the United States exceeds $1.1 billion per year.

[1]  M. Wilcox,et al.  Financial burden of hospital-acquired Clostridium difficile infection. , 1996, The Journal of hospital infection.

[2]  D. Pittet,et al.  Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. , 1994, JAMA.

[3]  C. Surawicz,et al.  The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  J. Bartlett,et al.  Postantibiotic Colonization with Clostridium difficile in Nursing Home Patients , 1990, Journal of the American Geriatrics Society.

[5]  W. Silen,et al.  The impact of Clostridium difficile on a surgical service: a prospective study of 374 patients. , 1998, Annals of surgery.

[6]  C. Surawicz,et al.  A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. , 1994, JAMA.

[7]  J. Starr,et al.  Increased risk of diarrhoea caused by Clostridium difficile in elderly patients receiving cefotaxime , 1995, BMJ.

[8]  G. Danan,et al.  Risk of diarrhoea due to Clostridium difficile during cefotaxime treatment , 1996, BMJ.

[9]  G E Bignardi,et al.  Risk factors for Clostridium difficile infection. , 1998, The Journal of hospital infection.

[10]  B. Goldin,et al.  SUCCESSFUL TREATMENT OF RELAPSING CLOSTRIDIUM DIFFICILE COLITIS WITH LACTOBACILLUS GG , 1987, The Lancet.

[11]  C. Pothoulakis,et al.  A receptor decoy inhibits the enterotoxic effects of Clostridium difficile toxin A in rat ileum. , 1996, Gastroenterology.

[12]  M. Samore,et al.  Clostridium difficile colonization and diarrhea at a tertiary care hospital. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[13]  T. Crabtree,et al.  Winner of the Best Paper Award from the Gold Medal Forum: Clinical Characteristics and Antibiotic Utilization in Surgical Patients with Clostridium difficile-Associated Diarrhea , 1999, The American surgeon.

[14]  D. Gerding,et al.  Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. , 1994 .

[15]  A. Vernava,et al.  Patterns and prognosis ofClostridium difficile colitis , 1994, Diseases of the colon and rectum.

[16]  Roger B. Davis,et al.  Seriously Ill Hospitalized Adults: Do We Spend Less on Older Patients? , 1996, Journal of The American Geriatrics Society.

[17]  T. Riley,et al.  Increased length of hospital stay due to Clostridium difficile associated diarrhoea , 1995, The Lancet.

[18]  C. Kelly,et al.  Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. , 2000, The New England journal of medicine.

[19]  R. Spencer Clinical impact and associated costs of Clostridium difficile-associated disease. , 1998, The Journal of antimicrobial chemotherapy.

[20]  D. Kleinbaum,et al.  Applied Regression Analysis and Other Multivariate Methods , 1978 .

[21]  D. Gerding,et al.  Ten Years of Prospective Clostridium difficile-Associated Disease Surveillance and Treatment at the Minneapolis VA Medical Center, 1982–1991 , 1994, Infection Control & Hospital Epidemiology.

[22]  M. Wilcox,et al.  Antibiotics and Clostridium difficile. , 1999, Microbes and infection.

[23]  G. Armstrong,et al.  Oligosaccharide sequences attached to an inert support (SYNSORB) as potential therapy for antibiotic-associated diarrhea and pseudomembranous colitis. , 1994, The Journal of infectious diseases.

[24]  D. Milligan,et al.  Clostridium difficile infection in allogeneic stem cell transplant recipients is associated with severe graft-versus-host disease and non-relapse mortality , 2000, Bone Marrow Transplantation.

[25]  R. Haley Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. , 1991, The American journal of medicine.

[26]  P Sharkey,et al.  The importance of severity of illness in assessing hospital mortality. , 1990, JAMA.

[27]  A. MacGowan,et al.  Health care resource utilization and antimicrobial use in elderly patients with community-acquired lower respiratory tract infection who develop Clostridium difficile-associated diarrhoea. , 1997, The Journal of antimicrobial chemotherapy.

[28]  C. Mackenzie,et al.  Assessing illness severity: does clinical judgment work? , 1986, Journal of chronic diseases.

[29]  D. Parham,et al.  Mortality due to C difficile colitis in elderly people has been underestimated , 1996, BMJ.

[30]  C. Pitchumoni,et al.  Prognostic criteria in Clostridium difficile colitis. , 1996, The American journal of gastroenterology.

[31]  S. Horn,et al.  Measuring Severity of Illness: Homogeneous Case Mix Groups , 1983, Medical care.

[32]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[33]  M. Samore Epidemiology of nosocomial clostridium difficile diarrhoea. , 1999, The Journal of hospital infection.

[34]  W. Stamm,et al.  Nosocomial acquisition of Clostridium difficile infection. , 1989, The New England journal of medicine.

[35]  L. Rosen,et al.  Clostridium difficile—A common and costly colitis , 1991, Diseases of the colon and rectum.

[36]  B. Aronsson,et al.  Medical implications of nosocomial infection with Clostridium difficile. , 1989, Scandinavian journal of infectious diseases.

[37]  A. MacGowan,et al.  Clostridium difficile-associated diarrhoea and length of hospital stay , 1995 .

[38]  J. Hicks Excessive blood drawing for laboratory tests. , 1999, The New England journal of medicine.

[39]  S. Meyers Clostridium difficile Colitis , 1999, American Journal of Gastroenterology.

[40]  C. Surawicz,et al.  Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. , 1990, The Journal of infectious diseases.