Costs of nosocomial Clostridium difficile-associated diarrhoea

Abstract number: P1470

Vonberg R.P., Reichardt C., Behnke M., Schwab F., Zindler S., Gastmeier P.

Objectives: Nosocomial Clostridium difficile-associated diarrhoea (CDAD) is a common infection in hospitals. A matched case-control study was done to determine hospital-wide excess costs due to CDAD.

Methods: Cases of CDAD were assessed by prospective hospital-wide surveillance in a tertiary care university hospital in 2006. Nosocomial CDAD cases (>72 hours after admission) were matched to control patients without CDAD in a ratio 1:3 using: (a) the same DRG in the same year, (b) a control's length of stay (LOS) leqslant R: less-than-or-eq, slant time frame of cases before infection, (c) a Charlson co-morbidity index ±1. Data on overall costs per case were provided from the financial controlling department. We excluded patients in psychiatry (who do not receive DRG codes) and paediatric patients. Evaluation of the application of matching criteria was done by Wilcoxon test for independent samples and Fisher's Exact test. Differences in LOS and costs between matched cases and controls were calculated following three parameters for the matched pairs: (a) difference in the LOS, (b) difference in costs per patient, (c) difference in costs per patient-day. For all parameters median with 95% confidence interval (CI95) non-parametric (distribution free) were calculated. A p-value <0.05 or a CI95 that excludes the zero were considered significant.

Results: There were a total of 116 CDAD cases in 2006. Data on costs were available for 103 CDAD cases (thereof 75 nosocomial CDAD cases). Out of 4,702 potential control patients, matching was possible for 45 nosocomial CDAD cases. Cases and controls did not differ with respect to age (p = 0.930), gender (p = 0.292), LOS on intensive care units (p = 0.463), and Charlson co-morbidity index (p = 0.902). The difference in the total LOS in the hospital showed that CDAD cases (median 27 days) stayed significant longer than their matched controls (median 20 days; p = 0.006). Overall costs for the 1,634 patient days of the 45 CDAD cases were 2,429,785 Euro (median 33,840 Euro per case) compared to 6,363,675 Euro for the 3,663 patient days for the 135 controls (median 18,981 Euro per control). CDAD cases were significant more expensive than their matched controls (median 7,147 Euro; CI95: 4,067–9,276).

Conclusion: Nosocomial CDAD is associated with high costs for healthcare systems. Clinicians should be aware of the financial impact of this disease, and application of appropriate infection control measures is recommended in order to avoid further pathogen spread.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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