Economic burden of recurrent Clostridioides difficile infection in adults admitted to Spanish hospitals. A multicentre retrospective observational study

Abstract

Introduction. Clostridioides difficile infection (CDI) is associated with increased hospital stays and mortality and a high likelihood of rehospitalization, leading to increased health resource use and costs. The objective was to estimate the economic burden of recurrent CDI (rCDI). Material and methods. Observational, retrospective study carried out in six hospitals. Adults aged ≥18 years with ≥1 confirmed diagnosis (primary or secondary) of rCDI between January 2010 and May 2018 were included. rCDI-related resource use included days of hospital stay (emergency room, ward, isolation and ICU), tests and treatments. For patients with primary diagnosis of rCDI, the complete hospital stay was attributed to rCDI. When diagnosis of rCDI was secondary, hospital stay attributed to rCDI was estimated using 1:1 propensity score matching as the difference in hospital stay compared to controls. Controls were hospitalizations without CDI recorded in the Spanish National Hospital Discharge Database. The cost was calculated by multiplying the natural resource units by the unit cost. Costs (euros) were updated to 2019. Results. We included 282 rCDI episodes (188 as primary diagnosis): 66.31% of patients were aged ≥65 years and 57.80% were female. The mean hospital stay (SD) was 17.18 (23.27) days: 86.17% of rCDI episodes were isolated for a mean (SD) of 10.30 (9.97) days. The total mean cost (95%-CI) per episode was €10,877 (9,499-12,777), of which the hospital stay accounted for 92.56%. Conclusions. There is high cost and resource use associated with rCDI, highlighting the importance of preventing rCDI to the Spanish National Health System.

Detection of Beta-Lactam-Resistant Escherichia coli and Toxigenic Clostridioides difficile Strains in Wild Boars Foraging in an Anthropization Gradient

“…Clostridioides difficile is a well-established pathogen of both humans and animals that contaminates foods and the environment [34]. In humans, C. difficile is the principal cause of antibiotic-associated diarrhea, emerging as a major infection associated with health care [21]. Genomic analyses have shown an overlap of C. difficile isolates from animals and people, suggesting that a zoonotic reservoir may contribute to recurrence [34].…”

“…In Spain, infection with C. difficile is the most common nosocomial infection and cause of antibiotic-associated diarrhea in hospitalized patients, with a high economic impact for the Spanish National Health System [21]. On the other hand, C. difficile is one of the most important uncontrolled causes of neonatal diarrhea in pig production, affecting one-weekold piglets in Catalonia [22], with a significant impact on the health and productivity of domestic pigs.…”

Optimising Antimicrobial Stewardship to Tackle Clostridioides difficile Infection and Improve Patient Outcomes

“…[26][27][28] In Spain, the cost of a recurrence of C. difficile requiring hospitalisation is estimated at 10,000 EUR. 29 "Recurrent infections have a big impact on patients' quality of life. They often feel depressed and may be in isolation, cutting them off from friends and family.…”

Treatment of Clostridioides difficile infection: from guidelines to clinical practice

“…In order to develop a clinical pathway, four basic pillars have been proposed [ 1 ] a structured and normally multidisciplinary intervention plan, [ 2 ] transfer of the scientific evidence or general clinical guidelines of the intervention plan to the local structures, [ 3 ] presentation of the steps involved in the course of treatment in detail, as a plan and algorithm and, [ 4 ] standardization of care for specified populations, as the ultimate goal [ 16 ].…”

“…Therefore, implementation of these guidelines is crucial, considering CDI is a serious health issue, not only for the individual patient (increasing early and late morbidity and mortality, and compromising the quality of life), but for the health system as well (involving the high cost of primary episodes and recurrences) [ 1 ], both of which pose a threat to the sustainability. So, a complete strategy has been put forward to optimize the way this infection is approached, at the level of each specific case, as well as at the collective level, inclusive of a “macro” vision of management planning from epidemiology to prevention, on a global scale.…”