Clostridium difficile claims a staggering toll in patient infections annually, and a new study estimates the cost of treatment is nearly $25,000 based on five days of hospitalization. Recurrent infections, not an uncommon phenomenon with C. diff, add an additional two days and another $10,500.

“This study is consistent with previous literature that has demonstrated a significant and substantial increase in [healthcare costs] for C. diff infection (CDI) over and above similar patients without CDI,” the authors reported. “It has also shown that having recurrent CDI is associated with substantial healthcare resource use as compared to similar CDI patients who do not have a recurrence. A significant strength of this study is that our data were drawn from a [broad] sample of the U.S. population, which increases its external validity.”

Of 55,500 C. diff patients analyzed in the study, roughly one-fourth were recurrent infections. In patients with at least one recurrence, the risk for subsequent infections increases to the 45% to 65% range. Risk factors for recurrent CDI include continuation of inappropriate antibiotics, advanced age, and the use of antacid medications, the authors reported.

Antibiotic stewardship is considered a prime preventive measure against C. diff, and almost two-thirds of the total patients received antimicrobials prior to their first infection.

“The most important risk factor for CDI is disruption of the normal intestinal flora by exposure to prolonged use of antibiotics,” the authors concluded. “Reports have shown that 18%-25% of patients will experience their first primary episode of CDI recurrence following the completion of treatment with vancomycin or metronidazole.”

That still leaves one-third caused by other factors, including transmission in healthcare settings by a spore-former that can resist environmental eradication. As infection preventionists are aware, these difficulties are compounded by the inability of alcohol hand rubs to inactivate C. diff spores on healthcare workers’ hands.

“The rate of healthcare-associated CDI has been increasing, and the diagnosis of CDI is estimated to raise the cost of a hospitalization stay by 54% in the United States,” they concluded.

“In addition, CDI has been associated with increasing morbidity and mortality, likely due to a combination of the changing virulence of C. difficile strains and the greater number of risk factors among vulnerable hospitalized patients.”

REFERENCE

1. Zhang D, Prabhu VS, Marcella SW, et al. Attributable Healthcare Resource Utilization and Costs for Patients with Primary and Recurrent Clostridium difficile Infection in the United States. Clin Infect Dis 2018; https://doi.org/10.1093/cid/cix1021. Published: 19 January 2018.