Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study

Shah, Dhara N.; Aitken, Samuel L; Barragan, L. F.; Bozorgui, Shima; Goddu, Sumana; Navarro, Marisa; Xie, Yang; DuPont, Herbert L.; Garey, Kevin W.

doi:10.1016/j.jhin.2016.04.004

Cited by 64 publications

(58 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Age over 85 years (OR 4.96, 95% CI; 1.4-17.6, P= 0.01) is a significant and strong independent predictor of CDI in multivariable analyses [14]. Thus extreme age, such as over 90 years old, is an important risk factor for CDI [15] and for developing complications or recurrence of CDI [12].…”

Section: Discussionmentioning

confidence: 96%

Nosocomial Clostridium difficile Infection among Patients Over 90 Years Old

Hirai¹,

Miyamae²,

Yamada³

et al. 2017

J Infect Dis Ther

View full text Add to dashboard Cite

Aim: Ageing population trends indicate that the median life expectancy in Japan is increasing. Clostridium difficile infection (CDI) can be a fatal nosocomial infection among the geriatric population. We examined clinical outcome and risk factors associated with death due to CDI among patients >90 years old.Methods: This retrospective observational study was performed to demonstrate the clinical characteristics of Patients >90 years who developed CDI between April 2010 and March 2015 at Tama-Hokubu Medical Center (a 344-bed community tertiary care hospital; average age of inpatients: 72 years). Diagnosis of CDI was confirmed via an enzyme-linked immunosorbent assay using stool sample. Multivariate analysis was performed to determine the independent risk factors associated with death.Results: Twenty-nine patients with CDI confirmed were identified. The mean age was 93 (90-100) years and 37.9% were women. Patients presented with hypertension (37.9%) and diabetes (33%) as underlying diseases, and 93.1% were admitted from long-term care facilities. The median period from admission to onset of CDI was 14 (2-73) days. The average episodes of diarrhea was 3.96 (1 to 10) times per day. The overall 90-day mortality rate was 34.5%. Multivariate analysis revealed that arrhythmia followed by onset of CDI (Odds Ratio, 8.0; 95% Confidence Interval, 1.37-46.8; P=0.021) was an independent risk factor associated with death. Conclusions:Arrhythmia followed by onset of CDI is a risk factor for death. Strict clinical management, including continuous monitoring of electrolyte and fluid balance and careful observation of patients >90 years old is crucial.

show abstract

Section: Discussionmentioning

confidence: 96%

Nosocomial Clostridium difficile Infection among Patients Over 90 Years Old

Hirai¹,

Miyamae²,

Yamada³

et al. 2017

J Infect Dis Ther

View full text Add to dashboard Cite

show abstract

“…26–30 In contrast, few studies have addressed similar outcomes among patients who experience rCDI. The studies that are available report significant increased likelihood of hospital readmission and mortality among patients with rCDI compared with those who do not experience rCDI.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Health Services Among Adults With RecurrentClostridium difficileInfection: A 12-Year Population-Based Study

Kipnis

et al. 2016

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

BACKGROUND Considerable efforts have been dedicated to developing strategies to prevent and treat recurrent Clostridium difficile infection (rCDI); however, evidence of the impact of rCDI on patient healthcare utilization and outcomes is limited. OBJECTIVE To compare healthcare utilization and 1-year mortality among adults who had rCDI, nonrecurrent CDI, or no CDI. METHODS We performed a nested case-control study among adult Kaiser Foundation Health Plan members from September 1, 2001, through December 31, 2013. We identified CDI through the presence of a positive laboratory test result and divided patients into 3 groups: patients with rCDI, defined as CDI in the 14–57 days after initial CDI; patients with nonrecurrent CDI; and patients who never had CDI. We conducted 3 matched comparisons: (1) rCDI vs no CDI; (2) rCDI vs nonrecurrent CDI; (3) nonrecurrent CDI vs no CDI. We followed patients for 1 year and compared healthcare utilization between groups, after matching patients on age, sex, and comorbidity. RESULTS We found that patients with rCDI consistently have substantially higher levels of healthcare utilization in various settings and greater 1-year mortality risk than both patients who had nonrecurrent CDI and patients who never had CDI. CONCLUSIONS Patients who develop an initial CDI are generally characterized by excess underlying, severe illness and utilization. However, patients with rCDI experience even greater adverse consequences of their disease than patients who do not experience rCDI. Our results further support the need for continued emphasis on identifying and using novel approaches to prevent and treat rCDI.

show abstract

“…In addition, recurrent CDI also increases the risk of person-to-person transmission [4]. A recent study focusing on the economic consequences of recurrent CDI compared to patients with CDI who did not experience a recurrence showed that there were substantially higher pharmacological and hospitalization costs among the patients with recurrent CDI [5]. …”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

et al. 2017

View full text Add to dashboard Cite

BackgroundClostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France.MethodsWe developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses.ResultsThree strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY.ConclusionsFMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

show abstract

Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study

Cited by 64 publications

References 21 publications

Nosocomial Clostridium difficile Infection among Patients Over 90 Years Old

Nosocomial Clostridium difficile Infection among Patients Over 90 Years Old

Utilization of Health Services Among Adults With RecurrentClostridium difficileInfection: A 12-Year Population-Based Study

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

Contact Info

Product

Resources

About