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Mortality and Costs in Clostridium difficile Infection Among the Elderly in the United States

Published online by Cambridge University Press:  30 August 2016

Andrew F. Shorr ,
Marya D. Zilberberg ,
Li Wang ,
Onur Baser  and
Holly Yu
Andrew F. Shorr
Affiliation:
Washington Hospital Center, Washington, DC
Marya D. Zilberberg*
Affiliation:
EviMed Research Group, Goshen, Massachusetts School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
Li Wang
Affiliation:
STATinMED Research, Ann Arbor, Michigan
Onur Baser
Affiliation:
STATinMED Research, Ann Arbor, Michigan Center for Innovation & Outcomes Research, Department of Surgery, Columbia University, New York, New York
Holly Yu
Affiliation:
Pfizer, Collegeville, Pennsylvania.
*
Address correspondence to Marya D. Zilberberg, MD, MPH, PO Box 303, Goshen, MA 01032 ([email protected]).
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Abstract

OBJECTIVE

To examine attributable mortality and costs of Clostridium difficile infection (CDI) in the Medicare population.

DESIGN

A population-based cohort study among US adults aged at least 65 years in the 2008–2010 Medicare 5% sample, with follow-up of 12 months.

PATIENTS

Incident CDI episode was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification code of 008.45 and no other occurrences within the preceding 12 months. To quantify the adjusted mortality and costs we developed a 1:1 propensity-matched sample of CDI and non-CDI patients.

RESULTS

Among 1,165,165 patients included, 6,838 (0.6%) had a CDI episode in 2009 (82.5% healthcare-associated). Patients with CDI were older (mean [SD] age, 81.0±8.0 vs 77.0±7.7 years, P<.001), were more likely to come from the Northeast (27.4% vs 18.6%, P<.001), and had a higher comorbidity burden (Charlson score, 4.6±3.3 vs 1.7±2.1, P<.001). Hospitalizations (63.2% vs 6.0%, P<.001) and antibiotics (33.9% vs 12.5%, P<.001) within the prior 90 days were more common in the group with CDI. In the propensity-adjusted analysis, CDI was associated with near doubling of both mortality (42.6% vs 23.4%, P<.001) and total healthcare costs ($64,807±$66,480 vs $38,128±$46,485, P<.001).

CONCLUSIONS

Among elderly patients, CDI is associated with an increase in adjusted mortality and healthcare costs following a CDI episode. Nationwide annually this equals 240,000 patients with CDI, 46,000 potential deaths, and more than $6 billion in costs.

Infect Control Hosp Epidemiol 2016;1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1331 - 1336
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

A.F.S. and M.D.Z. contributed equally to this article.

Presented in part: 55th Interscience Conference on Antimicrobial Agents and Chemotherapy meeting; San Diego, California; September 18–21, 2015.

References

REFERENCES

1. Healthcare Cost and Utilization Project (HCUP). HCUP projections: Clostridium difficile infection 2011 to 2012. Report 2012-01. HCUP website. http://www.hcup-us.ahrq.gov/reports/projections/CDI_Regional_projections_Final.pdf. Accessed August 12, 2016.Google Scholar
2. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar
3. Zilberberg, MD, Shorr, AF, Kollef, MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis 2008;14:929–931.CrossRefGoogle ScholarPubMed
4. Hall, AJ, Curns, AT, McDonald, LC, Parashar, UD, Lopman, BA. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clin Infect Dis 2012;55:216–223.CrossRefGoogle ScholarPubMed
5. US Census Bureau. 65+ in the United States: 2010 P23-212 Washington, DC: US Government Printing Office; 2014.Google Scholar
6. Kwon, JH, Olsen, MA, Dubberke, ER. The morbidity, mortality, and costs associated with Clostridium difficile infection. Infect Dis Clin N Am 2015;29:123–134.Google Scholar
7. Normand, ST, Landrum, MB, Guadagnoli, E, et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol 2001;54:387–398.Google Scholar
8. Baser, O. Choosing propensity score matching over regression adjustment for causal inference: when, why and how it makes sense. J Med Econ 2007;10:379–391.Google Scholar
9. 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.CrossRefGoogle ScholarPubMed
10. Berg, AM, Kelly, CP, Farraye, FA. Clostridium difficile infection in the inflammatory bowel disease patient. Inflamm Bowel Dis 2013;19:194–204.Google Scholar
11. Miller, MA, Hyland, M, Ofner-Agostini, M, Gourdeau, M, Ishak, M. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol 2002;23:137–140.Google Scholar
12. Dallal, RM, Harbrecht, BG, Boujoukas, AJ, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363–372.CrossRefGoogle ScholarPubMed
13. 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
14. Dubberke, ER, Butler, AM, Reske, KA, et al. Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis 2008;14:1031–1038.CrossRefGoogle ScholarPubMed
15. Gravel, D, Miller, M, Simor, A, et al. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009;48:568–576.Google Scholar
16. Tabak, YP, Zilberberg, MD, Johannes, RS, Sun, X, McDonald, LC. Attributable burden of hospital onset Clostridium difficile infection: a propensity score matching study. Infect Control Hosp Epidemiol 2013;34:588–596.Google Scholar
17. Pepin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005;173:1037–1042.Google Scholar
18. Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
19. Song, X, Bartlett, JG, Speck, K, Naegeli, A, Carroll, K, Perl, TM. Rising economic impact of Clostridium difficile-associated disease in adult hospitalized patient population. Infect Control Hosp Epidemiol 2008;29:823–828.Google Scholar
20. O’Brien, JA, Lahue, BJ, Caro, JJ, Davidson, DM. The emerging infectious challenge of Clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:1219–1227.Google Scholar
21. Stewart, DB, Hollenbeak, CS. Clostridium difficile colitis: factors associated with outcome and assessment of mortality at a national level. J Gastrointest Surg 2011;15:1548–1555.CrossRefGoogle ScholarPubMed
22. Lipp, MJ, Nero, DC, Callahan, MA. Impact of hospital-acquired Clostridium difficile . J Gastroenterol Hepatol 2012;27:1733–1737.Google Scholar
23. Pakyz, A, Carroll, NV, Harpe, SE, et al. Economic impact of Clostridium difficile infection in a multihospital cohort of academic health centers. Pharmacotherapy 2011;31:546–551.Google Scholar
24. Zilberberg, MD, Shorr, AF, Micek, ST, Kollef, MH. Clostridium difficile recurrence is a strong predictor of 30-day rehospitalization among patients in intensive care. Infect Control Hosp Epidemiol 2015;36:273–279.CrossRefGoogle Scholar
25. Olsen, MA, Yan, Y, Reske, KA, Zilberberg, M, Dubberke, ER. Impact of Clostridium difficile recurrence on hospital readmissions. Am J Infect Control 2015;43:318–322.Google Scholar
26. Dubberke, ER, Reske, KA, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.Google Scholar
27. Kitsios, GD, Dahabreh, IJ, Callahan, S, Paulus, JK, Campagna, AC, Dargin, JM. Can we trust observational studies using propensity scores in the critical care literature? A systematic comparison with randomized clinical trials. Crit Care Med 2015;43:1870–1879.Google Scholar
28. 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.Google Scholar
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