Economic burden of C. difficile similar in hospitalized children, adults

The economic burden of Clostridium difficile infection in children is similar to that of infection among adults, study data show.

“The epidemiology of CDI has changed to include populations previously considered to be at low risk, including healthy outpatients, peripartum women, individuals with no recent antibiotic exposure and children,” Preeti Mehrotra, MD, of Boston Children’s Hospital, and colleagues wrote. “…Studies of hospitalized adults with CDI have found attributable costs ranging from $3,000 to $15,000 per hospitalization and attributable length of stay of 3 to 7 days. While some studies have examined hospital charges for children with CDI, the true attributable cost of pediatric CDI remains poorly defined.”

The researchers evaluated discharge records of patients aged 2 to 18 years using the Agency for Healthcare Research and Quality Kids’ Inpatient Database. Mehrotra and colleagues created a logistic regression model to predict CDI during hospitalization, and then used the predicted probabilities from the model as propensity scores, matching CDI cases to non-CDI cases at a 2:1 ratio.

Mehrotra and colleagues reported 8,527 cases of CDI during pediatric hospitalizations (0.53%), as well as 1,597,513 discharges without CDI. Depending on whether the model was adjusted for length of stay, CDI that occurred during hospitalization carried an attributable cost ranging from $1,917 to $8,317. Hospitalizations with CDI cost 1.6 times more than hospitalizations not associated with CDI, the researchers reported. The attributable length of stay for CDI was 4 days.

“Defining the cost of CDI in children allows both clinical and policy stakeholders to better shape policies around prevention strategies in both the inpatient and outpatient settings,” the researchers wrote.

Suggested strategies included expansion of pediatric antimicrobial stewardship programs, developing novel outpatient antimicrobial stewardship programs and investment in infection preventionists.

“The case for such strategies is already thoughtfully being made for interventions to prevent CDI in adults, and these ideas should be extended to children as well,” Mehrotra and colleagues wrote. “Our innovative assessment of costs and [length of stay] in children should provide valuable support to these efforts.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.