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Study: C. difficile Infections Increase Lengths of Stay, Readmissions

Infections hike costs, increase risk of payment penalties, authors find

Clostridium difficile, one of the most common health care–associated infections, increases hospital costs by 40% per case and puts those infected at high risk for longer hospital stays and readmissions, according to a study published in the American Journal of Infection Control. The study was conducted by Premier, Inc., a health care improvement company, and Cubist Pharmaceuticals, which was recently acquired by Merck.

“In the last 15 years, C. difficile hospitalizations have increased by more than 200%,” said lead author Glenn Magee, MBA. “Although it’s commonly known that C. difficile  contributes to high costs and to 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. difficile 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. difficile, which can lead to severe diarrhea, pseudomembranous colitis, toxic megacolon, and death. Although little research is available to define the total cost and impact of C. difficile-related infections, estimates suggest that they may be associated with nearly $5 billion in U.S. health care costs annually, Premier estimates.

The study 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.

The results showed that C. difficile contributed to an increase of approximately 40% in costs per case or an average of $7,285 in additional costs. Costs were higher for patients with renal impairment ($8,942), an immunocompromised status ($8,692), or concomitant antibiotic exposure ($8,545). In addition, compared with patients without C. difficile infections, those infected experienced an estimated 77% higher risk of being readmitted within 30 days; a 55% longer hospital stay of nearly five days; and a 13% higher risk of mortality.

Most of the C. difficile cases in the study were associated with concomitant antibiotic use. The CDC suggests that people most at risk for C. difficile infections are those who take antibiotics and also receive medical care, especially older adults. This is because normal intestinal bacteria can be suppressed by antibiotics, providing an opportunity for difficult-to-treat bacteria, such as C. difficile, to take hold and cause severe and sometimes life-threatening infectious diarrhea.

It has been estimated that up to 50% of antibiotic use in hospitals is unnecessary and inappropriate, Premier says. Last year, the company published peer-reviewed research with the CDC showing that 78% of hospitals were overprescribing redundant combinations of intravenous antibiotics for two or more days.

The new 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, according to Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. “Many providers are already leading the effort to fight C. difficile 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,” she said.

In September, 50 Premier hospitals launched a national collaborative effort to test, define, and scale strategies to combat antibiotic-resistant bacteria. Their goal is to reduce the overuse of intravenous antibiotics by 20% and to implement the CDC’s core elements for antibiotic stewardship programs by July 2016.

In addition, providers have been able to significantly reduce C. difficile transmission and to 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.

Sources: Premier, Inc.; December 10, 2015; and AJIC; November 1, 2015.

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