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Attributable Inpatient Costs of Recurrent Clostridium difficile Infections

Published online by Cambridge University Press:  10 May 2016

Erik R. Dubberke ,
Eric Schaefer ,
Kimberly A. Reske ,
Marya Zilberberg ,
Christopher S. Hollenbeak  and
Margaret A. Olsen
Erik R. Dubberke*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Eric Schaefer
Affiliation:
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Kimberly A. Reske
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Marya Zilberberg
Affiliation:
EviMed Research Group, Goshen, Massachusetts; and University of Massachusetts, Amherst, Massachusetts
Christopher S. Hollenbeak
Affiliation:
Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, Box 8051, 660 South Euclid, St. Louis, MO 63110 ([email protected]).
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Abstract

Objective.

To determine the attributable inpatient costs of recurrent Clostridium difficile infections (CDIs)

Design.

Retrospective cohort study.

Setting.

Academic, urban, tertiary care hospital.

Patients.

A total of 3,958 patients aged 18 years or more who developed an initial CDI episode from 2003 through 2009.

Methods.

Data were collected electronically from hospital administrative databases and were supplemented with chart review. Patients with an index CDI episode during the study period were followed up for 180 days from the end of their index hospitalization or the end of their index CDI antibiotic treatment (whichever occurred later). Total hospital costs during the outcome period for patients with recurrent versus a single episode of CDI were analyzed using zero-inflated lognormal models.

Results.

There were 421 persons with recurrent CDI (recurrence rate, 10.6%). Recurrent CDI case patients were significantly more likely than persons without recurrence to have any hospital costs during the outcome period (P < .001). The estimated attributable cost of recurrent CDI was $11,631 (95% confidence interval, $8,937–$14,588).

Conclusions.

The attributable costs of recurrent CDI are considerable. Patients with recurrent CDI are significantly more likely to have inpatient hospital costs than patients who do not develop recurrences. Better strategies to predict and prevent CDI recurrences are needed.

Infect Control Hosp Epidemiol 2014;35(11):1400–1407

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1400 - 1407
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. Garey, KW, Sethi, S, Yadav, Y, Dupont, HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect 2008;70:298–304.CrossRefGoogle ScholarPubMed
2. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403–410.Google Scholar
3. Hebert, C, Du, H, Peterson, LR, Robicsek, A. Electronic health record–based detection of risk factors for Clostridium difficile infection relapse. Infect Control Hosp Epidemiol 2013;34:407–414.CrossRefGoogle ScholarPubMed
4. Kelly, CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect 2012;18(suppl 6):21–27.Google Scholar
5. Kim, JW, Lee, KL, Jeong, JB, et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World J Gastroenterol 2010;16:3573–3577.CrossRefGoogle ScholarPubMed
6. Kyne, L, Warny, M, Qamar, A, Kelly, CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001;357:189–193.Google Scholar
7. Linsky, A, Gupta, K, Lawler, EV, Fonda, JR, Hermos, JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010;170:772–778.Google Scholar
8. McFarland, LV, Surawicz, CM, Rubin, MS, et al. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999;20:43–49.Google Scholar
9. Pepin, J, Alary, ME, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.Google Scholar
10. Pepin, J, Routhier, S, Gagnon, S, Brazeau, I. Management and outcomes of a first recurrence of Clostridium difficile–associated disease in Quebec, Canada. Clin Infect Dis 2006;42:758–764.Google Scholar
11. Drekonja, DM, Amundson, WH, Decarolis, DD, Kuskowski, MA, Lederle, FA, Johnson, JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med 2011;124:1081–1087.Google Scholar
12. Nair, S, Yadav, D, Corpuz, M, Pitchumoni, CS. Clostridium difficile colitis: factors influencing treatment failure and relapse—a prospective evaluation. Am J Gastroenterol 1998;93:1873–1876.Google Scholar
13. Moshkowitz, M, Ben Baruch, E, Kline, Z, Shimoni, Z, Niven, M, Konikoff, F. Risk factors for severity and relapse of pseudomembranous colitis in an elderly population. Colorectal Dis 2007;9:173–177.Google Scholar
14. Petrella, LA, Sambol, SP, Cheknis, A, et al. Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clin Infect Dis 2012;55:351–357.CrossRefGoogle ScholarPubMed
15. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
16. Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.Google Scholar
17. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile–associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
18. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
19. Aitchison, J. On the distribution of a positive random variable having a discrete probability mass at the origin. J Am Stat Assoc 1955;50:901–908.Google Scholar
20. Cohn, TA, DeLong, LL. Estimating constituent loads. Water Resour Res 1989;25:937–942.Google Scholar
21. Albert, JM, Wang, W, Nelson, S. Estimating overall exposure effects for zero-inflated regression models with application to dental caries. Stat Methods Med Res 2014;23:257–278.Google Scholar
22. Dubberke, ER, Reske, KA, Olsen, MA, McDonald, LC, Fraser, VJ. Short- and long-term attributable costs of Clostridium difficile–associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497–504.Google Scholar
23. Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 2002;34:346–353.Google Scholar
24. Hogan, C, Lunney, J, Gabel, J, Lynn, J. Medicare beneficiaries’ costs of care in the last year of life. Health Aff (Millwood) 2001;20:188–195.Google Scholar
25. Riley, GF, Lubitz, JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res 2010;45:565–576.Google Scholar