The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study

• We collected data on Clostridium difficile infection (CDI) in Spain and Italy.
• We estimated the impact of CDI on length of hospital stay and costs by patient matching.
• We showed that length of hospital stay was significantly increased by CDI.
• We also showed that CDI was associated with considerable costs, mainly due to increased hospitalization.
• Treatments that reduce CDI severity and recurrence may reduce CDI burden.

SummaryObjectiveTo assess the impact of Clostridium difficile infection (CDI) on hospital resources and costs in Spain and Italy.MethodsCDI data were collected from institutions in Spain and Italy. Each patient was matched with two randomly selected uninfected controls in the same institution. Patient outcomes were assessed for the first and second episodes of CDI and for patients aged ≤65 and >65 years. The impact of CDI on hospital length of stay (LOS) was used to calculate CDI-attributable costs. A multivariate analysis using duration of stay as the continuous outcome variable assessed the independent effect of CDI on hospital costs and LOS.ResultsLOS attributable to CDI ranged from 7.6–19.0 days in adults and was 5.0 days in children; the increases were greater in adults in Italy than in Spain. Attributable costs per adult patient ranged from €4396 in Madrid to €14 023 in Rome, with the majority of the cost being due to hospitalization. For children, the total attributable cost was €3545/patient.ConclusionsThese data show that the burden of CDI is considerable in Spain and Italy. Treatments that can reduce LOS, disease severity, and recurrence rates, as well as effective infection control measures to prevent transmission, have the potential to reduce the burden of CDI.