August 03, 2019
2 min read

Hospital-acquired C. difficile linked to higher costs, longer stay

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Photo of Jenine Leal
Jenine R. Leal

Hospital-acquired Clostridioides difficile infection, or HA-CDI, was associated with a 27% increase in attributable costs and 13% increase in hospital length of stay compared with controls in a Canadian study published in Infection Control & Hospital Epidemiology.

“This suggests that fewer health care dollars and resources are available to treat and manage other patients due to a largely preventable outcome among hospitalized patients,” Jenine R. Leal, PhD, MSc, infection prevention and control-epidemiologist and senior surveillance consultant at Alberta Health Services, told Infectious Disease News.

In a retrospective, population-based, propensity score-matched cohort study, Leal and colleagues examined admitted adults aged 18 years or older at acute-care facilities in Alberta, Canada, with and without incident HA-CDI between April 1, 2012, and March 31, 2016. To calculate differences in cost, expressed in 2018 Canadian dollars, and length of stay, 98.4% of 2,916 HA-CDI cases were paired with 13,024 noncases.

According to the findings, the overall adjusted cost for HA-CDI cases was 27% greater than noncases (ratio, 1.27; 95% CI, 1.21-1.33). The mean attributable cost of an HA-CDI case was $18,386 (95% CI, $14,312-$22,460), and costs for both cases and noncases were driven by nursing, administration, and overhead costs, the researchers reported. The 13% higher adjusted length of stay among HA-CDI cases (ratio, 1.13; 95% CI, 1.07-1.19) corresponded to an extra 5.6 days in the hospital, the researchers reported.

According to the CDC, C. difficile is responsible for half a million illnesses in the United States each year — with elderly, extended-stay patients in nursing homes and hospitals at particularly high risk for infection.

“As infection prevention and control programs continue to introduce interventions to reduce HA-CDI and other hospital-acquired infections (HAIs), high-quality evidence on attributable costs and excess length of stay due to these infections, particularly in Canadian jurisdictions, is needed to support decision-making on appropriate interventions and disease management strategies,” Leal said. “Not factoring the time-varying nature of a HAI could result in inflated costs and length of stay.”

“Propensity score methods as used in this study is one approach, while other more advanced techniques such as multistate models could prove to be useful in accurately accounting for the time-dependent bias present in costing studies of HAIs,” Leal added. – by Eamon Dreisbach


CDC. C. diff factsheet. Accessed July 29, 2019.

CDC. What is C. diff? Accessed July 29, 2019.

Leal JR, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.178.

Disclosures: The authors report no relevant financial disclosures.