Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Hospital length of stay is considered a key driver of the economic burden of Clostridium difficileinfection (CDI).  The objective of this study was to estimate the incremental length of stay and costs for a sample of patients with CDI, compared to a sample of patients without CDI, both admitted to a Canadian tertiary-care hospital.

Methods: Using a frequency-matched cohort design, clinical and administrative data were extracted on 119 patients diagnosed with CDI and 240 patients without a CDI diagnosis hospitalized between April 1, 2008 and March 31, 2009.  The comparison sample was selected based on the distribution of resource intensity weights of the CDI sample. Mean (with 95% confidence intervals [95%CI]) and incremental costs for initial and recurrent infections were estimated using multivariable linear regression models with costs log transformed and adjusted for the following covariates: age, sex, number of comorbidities (classified by the number of unique International Classification of Diseases 10threvision (ICD-10) diagnostic codes assigned at discharge), suspected community-acquired CDI, number of CDI recurrences, use of intensive care, admission to the cardiac ward, or use of the operating room.

Results: The CDI cohort was not statistically younger (mean age of 65.7 vs. 68.4 years in the comparison sample) and had a similar proportion of men (56 vs. 60%), yet had a higher mean number of comorbidities (9.1 vs. 7.1; p=0.0016) than the comparison cohort. Including initial and recurrent infections, the length of stay was 14 days longer in the CDI sample (35.3 days vs. 21.1 days; p<0.0001).  After adjusting for covariates, the estimated incremental cost per initial CDI episode was $11,210 ($9,070-$13,340); and per recurrent infection, $14,400 ($11,705-$17,219).

Conclusion: For persons hospitalized with equally severe illness, we observed that a diagnosis of CDI leads to increased length of stay of two weeks which adds almost $12,000 in costs.  These data are useful to guide allocation of resources for prevention of CDI in hospital settings.

Shelagh Szabo, MSc1, Adrian Levy, PhD1, Greta Lozano-Ortega1, Elisa Lloyd-Smith, PhD2, Victor Leung, MD, FRCPC2, Tracey Ramsay3 and Marc G. Romney, MD, FRCPC, DTM&H4, (1)Oxford Outcomes, Vancouver, BC, Canada, (2)Providence Health Care, Vancouver, BC, Canada, (3)Optimer Pharma, Toronto, ON, Canada, (4)Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada


S. Szabo, None

A. Levy, Oxford Outcomes: Consultant, Consulting fee

G. Lozano-Ortega, None

E. Lloyd-Smith, None

V. Leung, None

T. Ramsay, Optimer: Employee, Salary

M. G. Romney, Pfizer: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.