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Clostridium difficile (C. diff), one of the most common healthcare-associated infections (HAIs), increases hospital costs by 40 percent per case and puts those infected at high risk for longer hospital stays and readmissions, according to a new study.
Published in the November issue of the American Journal of Infection Control, the study was conducted by Premier, Inc., a leading healthcare improvement company, and Cubist Pharmaceuticals, which was recently acquired by Merck & Co., Inc., one of the largest pharmaceutical companies in the world.
“In the last 15 years, C. diff hospitalizations have increased by more than 200 percent,” says Glenn Magee, MBA, lead author of the study and principal research scientist at Premier. “Although it’s commonly known that C. diff contributes to high costs and less than ideal outcomes, this study is the first to provide a complete look at how much of an impact it has on U.S. hospitals and patients. Efforts focused on preventing initial C. diff episodes, and targeted therapy to prevent recurrences for vulnerable patients, are essential to decrease this burden.”
According to the Centers for Disease Control and Prevention (CDC), each year approximately 500,000 people contract C. diff, which can lead to severe diarrhea, pseudomembranous colitis, toxic megacolon and death. Although there is little research available to define the total cost and impact of C. diff-related infections, estimates suggest that they may be associated with nearly $5 billion in U.S. healthcare costs annually.
The study, Impact of Clostridium difficile-associated diarrhea on acute-care length of stay, hospital costs, and readmission, analyzed patients discharged between January 2009 and December 2011. A retrospective analysis of inpatient hospital data was performed on 171,586 eligible discharges from approximately 500 U.S. hospitals in the Premier Healthcare Database. Results showed that C. diff contributed to an increase of approximately 40 percent in costs per case or an average of $7,285 in additional costs. Costs were higher for patients with renal impairment ($8,942), immunocompromised status ($8,692) and concomitant antibiotic exposure ($8,545). In addition, compared to patients without C. diff, those infected experienced an estimated:
• 77 percent higher chance of being readmitted within 30 days;
• 55 percent longer hospital stay of nearly five days; and
• 13 percent higher risk of mortality.
The majority of C. diff cases in the study were associated with concomitant antibiotic use. The CDC suggests that those most at risk for C. diff are people who take antibiotics and also receive medical care, especially older adults. This is because normal intestinal bacteria can become suppressed by antibiotics, providing an opportunity for very serious and hard to treat bacteria, such as C. diff, to take hold and cause severe and sometimes life threatening infectious diarrhea.
It has been estimated that up to half of antibiotic use in hospitals is unnecessary and inappropriate. In fact, last year Premier published peer-reviewed research with the CDC finding that 78 percent of hospitals were overprescribing redundant combinations of intravenous (IV) antibiotics for two or more days.
“Despite available therapies, C. diff infections remain a serious HAI risk for patients,” says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute®. “This research highlights an infection that providers should be paying extra attention to in order to keep patients safe and avoid unnecessary costs, including payment penalties. Many providers are already leading the effort to fight C. diff by implementing antimicrobial stewardship initiatives to control antibiotic use, optimizing clinical surveillance analytics to track infections and prescribing practices, implementing strict prevention techniques, and sharing best practices.”
Last September, 50 Premier hospitals came together to launch a national collaborative to test, define and scale strategies to combat antibiotic-resistant bacteria. Their goal is to reduce IV antibiotic overuse by 20 percent and implement the CDC’s core elements for antibiotic stewardship programs by July 2016.
Additionally, providers have been able to significantly reduce C. diff transmission and control outbreaks by implementing an array of infection prevention strategies, including the use of barrier precautions with gloves and gowns in a private room, if possible; strict adherence to hand washing; dedicated patient care items and equipment; and thorough environmental cleaning and decontamination of patient rooms.
Source: Premier, Inc.