Significant Costs Linked to Pediatric C. difficile Infection

Although the overall prevalence of Clostridium difficile infection has decreased following pediatric operations, the infection still poses a significant financial burden.

Researchers from Penn State University reviewed the Kids’ Inpatient Database to assess the burden of C. difficile infection in the population and to characterize the influence of the infection on the costs of care. In their report, the researchers explained that health care associated infections can impact one in 25 hospitalized patients, and that C. difficile was among the most common. The incidence of C. difficile infection among pediatric patients has been increasing over the past two decades.

The investigators used data from 2003, 2006, 2009, and 2012, finding 313,664 patients one to 18 years that underwent a general thoracic or abdominal procedure. They calculated the influence of the C. difficile infection on mortality, duration of hospital stay, and costs in similar patient cohorts compared to similar, though non-infected, groups.

The overall incidence of C. difficile infection in the population was 0.30%, though there was substantial variation across the different procedures. The three most common operations for the development of the infection were transplant (1.5%), large intestine (1.0%), and small intestine (0.86%). The three least common operations were appendiceal (0.15%), renal (0.23%), and hernia (0.26%).

The researchers also reported that the frequency of C. difficile infection increased over time — a finding that was aligned with previously published studies. In 2003, the prevalence was 0.22%, compared to 0.29% in 2006 and 2009, and rose to 0.39% in 2012.

Infected patients tended to be younger (for example, aged 1 to 6 years), have more comorbidities, and be covered by public insurance plans. The patients were also generally treated at larger hospitals, designated as urban teaching or children’s hospitals.

Compared to uninfected patients, the patients who were infected had a greater mortality rate, an increase length of stay of about 5.8 days, and higher mean costs: $33,575 compared to $12,525, respectively. The researchers also determined that 1,438 children developed a C. difficile infection, leading to 8,295 excess days spent in the hospital and $18.4 million in excess spending. Extrapolating this data for the general pediatric surgery population across the country, infection could affect nearly 7,000 patients with costs surpassing $50 million.

“The prevalence of C. difficile infection is rising, largely in part to the rise observed in children treated at non dedicated pediatric facility, or children’s hospitals within general hospitals,” study author Afif Kulaylat, MD, told MD Magazine in an email, adding that their study does not account for indirect costs such as parents missing work and the like.

“While the etiology of this phenomenon is not fully understood (nor is it captured within the scope of this study), it may reflect a rise in the acuity or complexity of children treated at non free standing children’s hospitals, as well as cross contamination from adult patients where a rise in the prevalence, virulence, and severity of C. difficile infection has been observed. In comparison to adults, an attributable increase in mortality was not observed in our study, which may indicate that the C. difficile infection increase in children has not been associated with an increase in severity of disease.”

The paper, titled “Costs of Clostridium difficile infection in pediatric operations: A propensity score—matching analysis,” was published in Surgery.

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