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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clostridium difficile infection.N Engl J Med. 2015; 372: 1539-1548
- The economic impact of Clostridium difficile infection: a systematic review.Am J Gastroenterol. 2015; 110: 511-519
- Increasing incidence of Clostridium difficile infection, Australia, 2011-2012.Med J Aust. 2014; 200: 272-276
- Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research.J Health Serv Res Policy. 2011; 16: 141-146
- A population-based longitudinal study of Clostridium difficile infection-related hospitalization in mid-age and older Australians.Epidemiol Infect. 2017; 145: 575-582
- Population by age and sex, Australia, 2006 [Internet].(Australian Bureau of Statistics; Available from) (Accessed November 2, 2015)
- Cohort profile: the 45 and Up Study.Int J Epidemiol. 2008; 37: 941-947
- International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM).5th ed. National Centre for Classification in Health, Sydney (New South Wales, Australia)2006
- Admitted patient data collection [Internet].(Available from) (Accessed August 10, 2014)
- Australian refined diagnosis related groups version 6.x addendum.2012
- (Available from) (Accessed Aug 2014)
- Australasian Society for Infectious Diseases guidelines for the diagnosis and treatment of Clostridium difficile infection.Med J Aust. 2011; 194: 353-358
- Round 14 (2009-2010) national public cost weight tables—version 6.0x and version 5.2. [Internet].(Canberra: Australian Government Department of Health and Aging; Available from) (Accessed April 3, 2015)
- Australia's health 2014.AIHW, Canberra2014 (Australia's health series no. 14. Cat. no. AUS 178)
- Increased length of hospital stay due to Clostridium difficile associated diarrhoea.Lancet. 1995; 345: 455-456
- Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.J Hosp Infect. 2014; 88: 12-21
- The effect of hospital-acquired Clostridium difficile infection on in-hospital mortality.Arch Intern Med. 2010; 170: 1804-1810
- Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients.Emerg Infect Dis. 2008; 14: 1031-1038
- Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs.BMC Med Res Methodol. 2010; 10: 26
- Accuracy of ICD-10 codes for surveillance of Clostridium difficile infections, France.Emerg Infect Dis. 2012; 18: 979-981
Article Info
Publication History
Published online: January 14, 2017
Footnotes
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.
Identification
Copyright
© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
