LAS VEGAS -- Among the many factors that contribute to the burgeoning costs of Clostridium difficile infections are long hospital stays, particularly in intensive care units, and the need for multiple specialist consultations, a chart review determined.
Among 500 patients diagnosed with C. difficile infection on admission or during hospitalization, 12.4% were cared for in an intensive care unit, and half of these required isolation, Swetha Rao Palli, MS, of HealthCore, in Wilmington, Del., reported in a poster session at the midyear clinical symposium of the American Society of Health-System Pharmacists.
Action Points
- Among the many factors that contribute to the burgeoning costs of Clostridium difficile infections are long hospital stays, particularly in intensive care units, and the need for multiple specialist consultations.
- Note that 12.4% of patients with C. diff infections stayed in the ICU for a mean length of stay of 12 days.
Mean length of stay in the intensive care unit was 12 days, she reported.
The 35% who were seen by gastroenterologists had a mean of nine consultations, and the 30% seen by infectious disease specialists had a mean of 12 visits.
And the average total cost for a single inpatient C. difficile infection was $35,621, according to Palli. "This study was an eye-opener," she told ѻý.
In the past decade C. difficile infections have become endemic in U.S. hospitals, but community-acquired infections also are on the rise.
Some 3 million cases are estimated to occur each year, with an excess cost burden for the healthcare system now exceeding $3 billion annually.
To explore the factors contributing to this, Palli and colleagues examined records from 500 patients enrolled in the HealthCore Integrated Research Database who had confirmed diagnoses of the infection.
Almost two-thirds of patients were women, and more than 70% were white. Their mean age was 66.
In 60%, the diagnosis of C. difficile infection was made at the time of admission, and other causes for hospitalization included pneumonia, renal impairment, and malignancies.
For those who developed the infection while hospitalized, the time to occurrence of symptoms was 7 days.
In 44%, the infection was rated as mild, meaning four to five unformed stools per day or a white blood cell count of 2,000/mm3, but in 35%, it was classified as severe, with 10 or more unformed bowel movements daily or a white blood cell count of 15,000/mm3 or more.
About half also experienced symptoms of abdominal pain, vomiting, and dehydration.
One in five patients had a previous history of C. difficile infection, and 6% of these had previously had an intensive care unit stay.
Numerous diagnostic tests were done, with 60% of patients having colonoscopies, endoscopies, CT or MRI scans, sigmoidoscopies, or tests for obstruction. Mucosal inflammation was identified in 16%, 2% required colectomy, and 0.4% had surgery for toxic megacolon.
Among patients who were given antibiotic treatment for their C. difficile infection, metronidazole (Flagyl) was most commonly used, and the average treatment duration was 5 days. However, 45% also received vancomycin, and the mean duration of treatment with this agent was 6 days.
Specialist consultations other than gastroenterology and infectious disease included intensivists in 5% and surgery in 25%.
A total of 7.6% of patients died during their hospital stay, with C. difficile infection being the cause of death in 21%.
In 85% of patients, the infection was ongoing at the time of discharge, and almost all of these had post-discharge prescriptions for metronidazole, vancomycin, and/or rifaximin.
"These increasingly common and severe infections are associated with long inpatient stays and high resource utilization, and result in a substantial economic burden," Palli concluded.
Disclosures
The authors reported no financial disclosures.
Primary Source
American Society of Health-System Pharmacists
Source Reference: Palli S, et al "Cost drivers associated with Clostridium difficile infection in a hospital setting" ASHP 2012; Abstract 5-147.