Major articleImpact of Clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: A multicenter retrospective study of inpatients, 2009-2011

•We used the Premier database to determine Clostridium difficile-associated diarrhea burden on U.S. acute care hospitals.•Patients with Clostridium difficile-associated diarrhea had higher lengths of stay, intensive care unit admission, and inpatient mortality.•Clostridium difficile-associated diarrhea also conferred higher adjusted costs and all-cause readmissions.•Clostridium difficile-associated diarrhea-attributable costs and readmissions were also higher in high-risk subgroups.•Prevention of initial and recurrent Clostridium difficile-associated diarrhea is essential to lessen burden to hospitals.

BackgroundThe recent epidemiologic changes of Clostridium difficile-associated diarrhea (CDAD) have resulted in substantial economic burden to U.S. acute care hospitals. Past studies evaluating CDAD-attributable costs have been geographically and demographically limited. Here, we describe CDAD-attributable burden in inpatients, overall, and in vulnerable subpopulations from the Premier hospital database, a large, diverse cohort with a wide range of high-risk subgroups.MethodsDischarges from the Premier database were retrospectively analyzed to assess length of stay (LOS), total inpatient costs, readmission, and inpatient mortality.ResultsPatients with CDAD had significantly worse outcomes than matched controls in terms of total LOS, rates of intensive care unit (ICU) admission, and inpatient mortality. After adjustment for risk factors, patients with CDAD had increased odds of inpatient mortality, total and ICU LOS, costs, and odds of 30-, 60- and 90-day all-cause readmission versus non-CDAD patients. CDAD-attributable costs were higher in all studied vulnerable subpopulations, which also had increased odds of 30-, 60- and 90-day all-cause readmission than those without CDAD.ConclusionGiven the significant economic impact CDAD has on hospitals, prevention of initial episodes and targeted therapy to prevent recurrences in vulnerable patients are essential to decrease the overall burden to hospitals.