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Data released at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2017 demonstrate the impact of CDI on the health service amounts to 10,670 bed days over a year, the equivalent to a fully occupied 30 bed ward, with each CDI case costing approximately £7,500. In addition, the study conducted by the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI), reveals that a sixth of patients cured of the initial CDI recur within three months and nearly one-third of those have a second recurrence within a year. The SHAIPI CDI study investigated the clinical outcomes following hospitalization of patients with CDI in Scotland and consisted of two analyses; the first analysis aimed to understand the impact of the infection;4 the second investigated clinical outcomes in community-associated CDI (CA-CDI) and hospital-associated CDI (HA-CDI).
CDI costs healthcare services approximately €3 billion across Europe each year. Recurrence of CDI occurs in up to 25 percent of patients within 30 days of initial treatment with broad-spectrum antibiotics and patients with one recurrence have an estimated 40 percent risk of a further episode. Recurrent CDI is associated with increased mortality rates and longer hospital stays. CDI is more common in those taking antibiotics, the elderly, transplant patients, those with underlying diseases and hospital patients.
Professor Alistair Leanord, a consultant microbiologist at the University of Glasgow, commented, “We have seen large reductions in CDI in the UK over the last decade, however, there has been little change in the rates of recurrence and death as a result of Clostridium difficile infection. This study shows that patients with CDI, whether community or hospital associated, have a doubling of mortality, and a longer length of stay with a significant cost to the NHS. We now have a clearer understanding of the national burden of CDI in terms of recurrences, deaths, cost to the healthcare service and the increasing importance of community acquisition of infection. This will allow us to target future interventions in a more focused, cost effective manner to improve patients’ care.”
The study was undertaken by the universities of Glasgow, Strathclyde and Dundee, and data was analysed from 3,304 hospital cases of CDI and 9,516 controls from August 2010 to July 2013. Of the total number of CDI cases recorded, 58 percent came from female patients. In terms of mortality, 29 percent of those with CDI died within two months compared to 14 percent of control cases and hazard ratio of death was also found to be 2.1 times greater for CDI cases compared to controls (95% 1.9, CI 2.5). With regard to time spent in hospitals, those with CDI had an estimated additional length of stay of 9.7 days compared to controls.
The second data analysis consisted of 1,297 CA-CDI cases and 3,980 controls and 2,007 HA-CDI cases and 5,536 controls. Results suggest that, compared to controls, mortality rates are higher amongst HA-CDI cases (33.0% vs 17.7%) than in CA-CDI cases (22.4% vs 9.6%). Median length of stay was 7.2 days greater than controls for CA-CDI cases and 12.0 days greater for HA-CDI cases.5
Mark Wilcox, professor of medical microbiology at Leeds Teaching Hospitals & University of Leeds, commented, “These new studies focus on the outcomes associated with CDI, including community- and hospital-associated cases. The findings, based on large groups of cases and control patients, emphasize the considerable healthcare and societal burdens of CDI. Notably there was a doubling risk of death for both community- and hospital-associated CDI cases compared with (non-CDI) control patients.” He continued, “Furthermore, the lengths of hospital stay for both groups of CDI cases was about twice as long as that for controls; these add up to a substantial burden on the NHS, at a time of major service pressures. The figures mean that we must optimize efforts to prevent CDI and to treat cases optimally to reduce the risk of recurrent infections.”
Reducing the threat and the burden of infectious diseases like CDI is increasingly linked to antibiotic stewardship.18 In this context, inappropriate use of antibiotics may cause the development of antimicrobial resistance,19 increasing risk of CDI and other medical complications.13,15,20 CDI is also often treated with broad-spectrum antibiotics that further damage the ‘good’ bacteria, increasing the risk of the CDI returning.10,21 Refining and optimizing the use of antibiotics in the treatment of CDI therefore has the potential to serve as an accepted practice example for antibiotic stewardship in the treatment of infectious diseases.