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CDI recurrence linked to higher mortality, health care costs
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Recurring Clostridium difficile infection, or CDI, is linked to increased mortality rates and significantly higher health care costs, according to researchers.
Two studies presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) compiled data on the effects of the disease, particularly on older patients.
“The main risk factor for developing CDI is prior antibiotic use,” David Enoch, MBBS, MSc, an infection control clinician with Public Health England in Cambridge and a researcher in one of the studies, said in a news release. “Older people are at greater risk of CDI, as they are often sicker, have other illnesses or conditions and so need more antibiotics.”
Enoch and colleagues analyzed data for 6,874 patients diagnosed with CDI in English hospitals between Jan. 1, 2002, and Dec. 31, 2013. The mean patient age was 77.6 years, and the mean length of hospital stay was 38.3 days.
According to the researchers, 1,141 (16.6%) of the patients had recurrent CDI. Of those, 564 (49%) died within 12 months, compared with 2,194 (38%) of those without CDI recurrence (P < .001). Recurrent CDI was associated with a significantly higher risk for death within 12 months (HR = 1.71), even after adjusting for patient demographics and clinical characteristics before their initial CDI diagnosis.
In addition, 243 (21%) patients with recurring CDI had nonfatal complications, compared with 1,050 (18%) without recurrence.
Enoch said prevention is an important step in fighting CDI.
“Although much has been done, particularly in the U.K., to try to prevent CDI, strict adherence to antibiotic guidelines by clinicians and thorough cleaning of the hospital environment are crucial in ensuring that patients don’t develop CDI in the first place,” he said in the news release.
Another study, conducted in Scotland, included 3,304 hospital cases of CDI between August 2010 and July 2013, matched to a control group of 9,516 patients without the infection. In all, 22% of patients with CDI died before discharge, compared with 9% of the control patients.
Likewise, 29% percent of patients with CDI died within 2 months, compared with 14% of control patients. The risk for death among patients with CDI was significantly higher than that for controls (HR = 2.2).
Age played a role in CDI effects as well. Patients aged 75 years and older had about twice the risk for recurring CDI, compared with those aged 65 years and younger.
Those aged between 65 and 74 years were 1.5 times more likely to have recurring infection as younger patients.
Patients with CDI also experienced much longer and costlier hospital stays, the researchers found. Those patients had an estimated 10.3 more days in hospital than the control group.
The additional effects of CDI equate to 11,300 bed days per year in Scotland, the researchers said.
“This is the equivalent of a 30-bed hospital ward being fully occupied all year,” researcher Alistair Leanord, MD, director of the Scottish Infection Research Network and principal investigator for the Scottish Healthcare Associated Infection Prevention Institute, said in the news release.
The average cost associated with a patient with CDI was 7,500 pounds, compared with 2,800 pounds for those without the infection, according to Leanord. In addition, the cost to Scotland’s National Health Service of 1,150 cases between 2015 and 2016 came to 8,650,000 pounds, compared with the 1,955,000 pounds associated with normal hospital care during that period.
Leanord summed up ways to address the increased costs.
“Having a clear understanding of the nature of CDI in Scotland will allow the Scottish government to target resources at the most appropriate patients to try to reduce the overall burden of the disease on the health service,” he said. “Our findings are very likely to be applicable to the rest of the U.K. and other countries as well.” – by Joe Green
Reference:
Enoch D, et al. Abstract EP0181. Presented at: European Congress of Clinical Microbiology and Infectious Diseases; April 22-25, 2017; Vienna.
Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.