Hostname: page-component-cb9f654ff-kl2l2 Total loading time: 0 Render date: 2025-08-30T13:10:35.683Z Has data issue: false hasContentIssue false
  • English
  • Français

Review of Current Literature on the Economic Burden of Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke  and
Albert I. Wertheimer
Erik R. Dubberke*
Affiliation:
Infectious Diseases Division, Department of Medicine, Washington University in St. Louis, School of Medicine, St. Louis, Missouri
Albert I. Wertheimer
Affiliation:
Center for Pharmaceutical Services Research and Pharmacoeconomics, Temple University School of Pharmacy, Philadelphia, Pennsylvania
*
Infectious Diseases Division, Department of Medicine, Washington University in St. Louis, School of Medicine, 660 S. Euclid Ave., Box 8051, St. Louis, MO 63110 (edubberk@im.wustl.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Clostridium difficile is well recognized as the most common infectious cause of healthcare-associated diarrhea. Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and virulent illness that is often refractory to treatment. An analysis by the Centers for Disease Control and Prevention revealed that, in the United States, the number of patients discharged from hospitals who received the International Classification of Diseases, Ninth Revision discharge diagnosis code for C. difficile infection (CDI) more than doubled from 2000 to 2003. Unpublished data indicate that this trend has continued and that more than 250,000 US hospitalizations were associated with CDI in 2005. A previously uncommon hypervirulent strain of C. difficile is thought to contribute, in part, to the dramatic increase in the incidence and severity of the infection. Although the economic impact of the disease is believed to be profound and is expected to increase, data on the costs associated with CDI are scarce. To more completely assess its economic burden, we performed a review of available literature that reported costs associated with the infection.

Information

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 1 , January 2009 , pp. 57 - 66
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
2.Bartlett, JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334–339.Google Scholar
3.Gerding, DN, Olson, MM, Peterson, LR, et al. Clostridium difficile-associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study. Arch Intern Med 1986;146:95–100.CrossRefGoogle ScholarPubMed
4.Kelly, CP, Pothoulakis, C, LaMont, JT. Clostridium difficile colitis. N Engl J Med 1994;330:257–262.Google Scholar
5.Fekety, R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol 1997;92:739–750.Google ScholarPubMed
6.Hurley, BW, Nguyen, CC. The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea. Arch Intern Med 2002;162:2177–2184.CrossRefGoogle ScholarPubMed
7.Bartlett, JG, Chang, TW, Gurwith, M, Gorbach, SL, Onderdonk, AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing Clostridia. N Engl J Med 1978;298:531–534.Google Scholar
8.Poutanen, SM, Simor, AE. Clostridium difficile-associated diarrhea in adults. CMAJ 2004;171:51–58.Google Scholar
9.Warny, M, Pepin, J, Fang, A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.Google Scholar
10.Price, MF, Dao-Tran, T, Garey, KW, et al. Epidemiology and incidence of Clostridium difficile-associated diarrhoea diagnosed upon admission to a university hospital. J Hosp Infect 2007;65:42–46.CrossRefGoogle ScholarPubMed
11.McFarland, LV, Surawicz, CM, Rubin, M, Fekety, R, Elmer, GW, Greenberg, RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999;20:43–50.Google Scholar
12.Sunenshine, RH, McDonald, LC. Clostridium difficile-associated disease: new challenges from an established pathogen. Cleve Clin J Med 2006;73:187–197.CrossRefGoogle ScholarPubMed
13.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.CrossRefGoogle ScholarPubMed
14.Loo, VG, Poirier, L, Miller, MA, et al. A predominandy clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. New Engl J Med 2005;353:2442–2449.Google Scholar
15.Pépin, J, Valiquette, L, Alary, ME, et al. Clostridium difficile-assocated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.CrossRefGoogle Scholar
16.Centers for Disease Control and Prevention. Severe Clostridium difficile-associated disease in populations previously at low risk: four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:1201–1205.Google Scholar
17.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis 2006;12:409–415.Google Scholar
18.McDonald, LC. Confronting Clostridium difficile in inpatient health care facilities. Clin Infect Dis 2007;45:1274–1276.Google Scholar
19.Pépin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hvpervirulent strain in Quebec. CMAJ 2005;173:1037–1042.Google Scholar
20.Kuijper, EJ, Coignard, B, Brazier, JS, et al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007;12:E1–E2.Google Scholar
21. Centers for Disease Control and Prevention. Clostridium difficile infections. Data and statistics about Clostridium difficile infections. Available at: http://www.cdc.gov/ncidod/dhqp/id_Cdiff_data.html. Accessed March 18, 2008.Google Scholar
22.Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonald, LC, Fraser, VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45:1543–1549.Google Scholar
23.Dial, S, Delaney, JA, Barkun, AN, Suissa, S. Use of gastric-acid-suppressive agents and the risk of community-acquired Clostridium-associated disease. JAMA 2005;294:2989–2995.CrossRefGoogle Scholar
24.Dial, S, Alrasadi, K, Manoukian, C, Huang, A, Menzies, D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004;171:33–38.Google Scholar
25.Cadle, RM, Mansouri, MD, Logan, N, Kudva, DR, Musher, DM. Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis. Am J Health Syst Pharm 2007;64:2359–2363.CrossRefGoogle ScholarPubMed
26.McMullen, K, Zack, J, Coopersmith, CM, Kollef, M, Dubberke, ER, Warren, DK. The use of hypochlorite solution to lower rates of Clostridium difficile–associated diarrhea. Infect Control Hosp Epidemiol 2007;28:205–207.CrossRefGoogle Scholar
27. Centers for Disease Control and Prevention. Frequently asked questions. Information for healthcare providers. Available at: http://www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_HCP.html#9. Accessed January 28, 2008.Google Scholar
28.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. MMWR Recomm Rep 2002;51(RR-16):1–45.Google Scholar
29.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346–353.CrossRefGoogle ScholarPubMed
30.O'Brien, JA, Lahue, BJ, Caro, JJ, Davidson, DM. The emerging infectious challenge of Clostridium difficile–associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:1219–1227.Google Scholar
31.Dubberke, ER, Reske, KA, Olsen, MA, McDonald, LC, Fraser, VJ. Short-and long-term attributable costs of Clostridium difficile–associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497–504.CrossRefGoogle ScholarPubMed
32.Climo, MW, Israel, DS, Wong, ES, Williams, D, Coudron, P, Markowitz, SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989–995.CrossRefGoogle ScholarPubMed
33.Lahue, BJ, Davidson, DM. Metronidazole and vancomycin outcomes for Clostridium difficile-associated diarrhoea in a US hospital database. In: 17th European Congress of Clinical Microbiology and Infectious Diseases; March 31–April 3, 2007; Munich, Germany. Abstract 1732_215.Google Scholar
34.Lawrence, SJ, Puzniak, LA, Shadel, BN, Gillespie, KN, Kollef, MH, Mundy, LM. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007;28:123–130.Google Scholar
35.Teasley, DG, Olson, MM, Gebhard, RL, et al. Prospective randomised trial of metronidazole versus vancomycin for Clostridium difficile-associated diarrhoea and colitis. Lancet 1983;2:1043–1046.CrossRefGoogle ScholarPubMed
36.Reed, JF, Edris, BA, Eid, S. Clostridium difficile: the new epidemic. In: 45th Annual Meeting of the Infectious Diseases Society of America; October 4–7, 2007; San Diego, California. Poster 816.Google Scholar
37.Butterworth, SA, Koppert, E, Clarke, A, Wiggs, B, MacFarlane, JK. Recent trends in diagnosis and treatment of Clostridium difficile in a tertiary care facility. Am J Surg 1998;175:403–407.Google Scholar
38.Miller, MA, Hyland, M, Ofner-Agostini, M, Gourdeau, M, Ishak, M; Canadian Hospital Epidemiology Committee; Canadian Nosocomial Infection Surveillance Program. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol 2002;23:137–140.CrossRefGoogle Scholar
39.Al-Eidan, FA, McElnay, JC, Scott, MG, Kearney, MP. Clostridium difficile-associated diarrhoea in hospitalised patients. J Clin Pharm Ther 2000;25:101–109.Google Scholar
40.Riley, TV, Coddle, JP, Rouse, IL. Increased length of hospital stay due to Clostridium difficile associated diarrhoea. Lancet 1995;345:455–456.Google Scholar
41.Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:23–30.CrossRefGoogle ScholarPubMed
42. US Department of Labor. Bureau of Labor Statistics. Consumer Price Index. Available at: http://www.bls.gov/cpi/. Accessed August 21, 2008.Google Scholar
43. OANDA.com. The Currency Site. FXConverter—Currency Converter for 164 Currencies. Available at: http://www.oanda.com/convert/classic. Accessed August 21, 2008.Google Scholar
44.Pépin, J, Alary, M-E, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:1591–1597.Google Scholar
45.Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.Google Scholar
46.Zar, FA, Bakkanagari, SR, Moorthi, KMLST, Davis, MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile–associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302–307.Google Scholar
47.McFarland, LV. Alternative treatments for Clostridium difficile disease: what really works? J Med Microbiol 2005;54(Pt 2):101–11.Google Scholar
48.Kofsky, P, Rosen, L, Reed, J, Tolmie, M, Ufberg, D. Clostridium difficile–a common and costly colitis. Dis Colon Rectum 1991;34:244–248.CrossRefGoogle ScholarPubMed
49.Graves, N, Weinhold, D, Tong, E, et al. Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol 2007;28:280–292.Google Scholar
50.Gold, MR, ed. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.Google Scholar
51.Paladino, JA, Sunderlin, JL, Price, CS, Schentag, JJ. Economic consequences of antimicrobial resistance. Surg Infect (Larchmt) 2002;3:259–267.Google Scholar
52.Centers for Medicare and Medicaid Services (CMS). Press release: CMS proposes to expand quality program for hospital inpatient services in FY 2009. April 14, 2008. Available at: http://www.medicalnewstoday.com/articles/104029.php. Accessed August 21, 2008.Google Scholar