Clostridium difficile Infection

Purpose: We retrospectively reviewed hospital records to investigate the relative risk of Clostridium difficile (C. diff) infection with specific antibiotics and to quantify the potential economic impact of nosocomial C. diff. Methods: Records were reviewed for all patients admitted between September 1, 2003, and August 31, 2005, who had a discharge diagnosis that included C. diff infection. This group was compared with age and primary diagnosis matched control without C. diff infection from the general hospital database at the time. Controls and C. diff cases all were also matched by the initial pre-C. diff length of stay (LOS). To avoid cases with pre-hospitalization infection, patients were included in the C. diff group only if they had proven C. diff infections identified after hospital day three. Those identified before hospital day three were considered community acquired and were excluded. Antibiotic utilization was determined from the hospital pharmacy database reported in terms of antibiotic days. Results: There were 241 positive assays for C. diff, 120 community acquired and 121 hospital acquired. We were able to match 103 of the hospital-acquired cases with controls. Average LOS was 8.7 days longer in the C. diff group compared to controls. Of the 121 hospital-acquired cases, 68 received ceftriaxone therapy, 46 vancomycin, 28 ceftazadine, 13 cefazolin, 13 clindomycin, 12 metroziniazole, and 7 ampicillin. Fifteen cases had no apparent hospital antibiotic treatment. Many patients received multiple or simultaneous courses with different antibiotics. Although cefazolin and ceftriaxone had nearly equal utilization, five times more C. diff cases were reported with ceftriaxone than with cefazolin. With hospital costs averaging an estimated $1200 a day, the average C. diff-associated LOS prolongation of 8.7 days represented an average additional cost of approximately $10,000 per infected patient. Conclusions: In studies outside the U.S., newer generation cephalosporins have been identified as frequently associated with the risk of C. diff infection. We found similar results that confirmed the dramatic impact on LOS and hospital costs caused by C. diff infection associated with third-generation cephalosporins. As has been done elsewhere with success, hospitals should consider antibiotic restrictions.