Better Outcomes, Higher Costs for C Difficile Infections in Recent Years

Raseen Tariq, MBBS

New research shows hospitalizations and overall hospital length of stays (LOS) have decreased between 2006-2018, while costs continue to go up for clostridium difficile infections (CDI).

A team, led by Raseen Tariq, MD, Mayo Clinic, examined trends and characteristics of C difficile infection-related hospitalizations between 2006-2018 in data presented during the 2021 American College of Gastroenterology (ACG) Annual Meeting.

CDI is currently the most common nosocomial infection that is highly associated with increased inpatient and outpatient costs and health care burden.

In the study, the investigators identified patients admitted with primary or secondary diagnosis of CDI using data from the National Inpatient Sample database.

Patients were evaluated based on ICD-9 or ICD-10 codes.

Identifying Trends

The investigators identified trends in nationwide estimates for annual admissions with CDI, age at admission, length of stay, in-patient mortality, Charlson Comorbidity Index, and total hospital charge, which was adjusted for inflation.

The team also used Cochran-Armitage tests for trend significance and weights provided in the database to make nationwide estimates.

Positive Trends

Overall, hospital admissions for CDI increased between 2006-2011.

In 2006 admissions were 310,840, compared to 375,770 in 2011, which was the peak of the entire study period.

What followed next was a decline to the overall lowest level in 2018, with 298,930 individuals admitted to the hospital with CDI.

The median age of admission also decreased throughout the study.

For example, the median age of admission was 74 years when the study began in 2006 and steadily declined to 66.26 years in 2018 (P <0.01).

Similar results were found for length of hospital stay, which declined from 12.62 days in 2006 to 9.87 days in 2018 (P <0.01).

In addition, the average length of stay for patients with a primary diagnosis of C difficile infection declined from 7.04 days in 2006 to 5.36 days in 2018 (P <0.01).

While the Charlson Comorbidity Index increased throughout the study, from 1.59 (SE, 0.005) to 2.09 (SE, 0.006) (P <0.01), the in-patient mortality significantly decreased during this same period, from 9.2% to 6.0% (P <0.01).

After the investigators adjusted for inflation, the total charges for hospitalization increased from $28,203 to $50,194 (P <0.01) for a primary diagnosis of CDI and from $74,079 to $161,161 for a secondary diagnosis of CDI.

“The number of CDI related hospitalizations have declined from 2011 with an increase in the cost of care, which may be related to a corresponding increase in comorbidities,” the authors wrote. “LOS and inpatient mortality has steadily declined since 2006 suggesting better management of CDI related hospitalizations.”

Best Practices

Earlier this year, investigators found by implementing best practice advisory (BPA) principals, clinicians can help reduce the occurrence of recurrent CDI.

In the quasi-experimental study, the investigators examined patients at more than 50 primary, specialty, and urgent-care clinics.

CDI recurrence decreased, where just 7% of the best practice advisory group had an infection recurrence within 14-56 days of the initial episode. This was compared to 27% of the non-BPA group (P <.001).

The study, “Trends in Admissions, Outcomes and Financial Burden of C. difficile Infection-Related Hospitalizations: A Nationwide Analysis,” was published online by ACG.