Clostridium difficile: The new epidemic

摘要

Introduction: Currently Clostridium difficile associated disease (CDAD) is the most common cause of infectious diarrhea in hospitals and long-term care homes in the United States. We report prevalence of CDAD among selected DRG's and its impact on mortality rates, mean length of stay (LOS), and total patient costs at a large community, teaching hospital.Methods: Data were abstracted using the hospital's administrative data warehouse. 9,164 patients with a hospital admission between 01/01/2002 and 12/31/2006, assigned a DRG of Heart Failure & Shock, major small and large bowel procedures, Esophagitis both with and without complications and comorbidities, OR procedures for infectious diseases, and Septicemia were included.Results: LOS for patients with CDAD was more than double that for patients without CDAD (13.5 ± 14.9 days versus 5.4 ± 5.6 days, p = 0.001). Average charges for patients with CDAD was tripled ($24,854 ± $41,095 versus $7,704 ± $11,061, p = 0.001). The hospital length of stay doubled in four of the five DRGs. The patient cost also doubled in the same DRGs.Conclusion: Patients with CDAD typically have mean LOS and average costs double that of patients without CDAD. Introduction From 1995 to 2005, the number of Pennsylvania hospitalizations for Clostridium difficile-associated disease (CDAD) increased from 7,026 to 20,941. This represents an amazing 173% increase, from 4.4 cases per 1,000 hospitalizations to 12.0 per 1,000 hospitalizations. Patients with CDAD were hospitalized over twice as long, charged more than twice as much, and were four times as likely to die as patients without CDAD. 16 Antibiotic-associated diarrhea and colitis became well established soon after antibiotics were first made available. By 1978, Clostridium difficile became the prevalent pathogen in the majority of cases where antibiotics were related to such intestinal distress. 2 The most prescribed antibiotic was clindamycin and the standard management was to withdraw the implicated antibiotic and begin treating with vancomycin. From 1983 through 2003, the most commonly implicated antibiotics were cephalosporins and metronidazole replaced vancomycin as the standard treatment while principles of containment became infection control and antibiotic control. From 2003 to 2006, Clostridium difficile (NAP1, BI, or 027) emerged as the most virulent and common cause of infectious diarrhea in hospitals and long-term care homes in the United States, Japan and Europe. 2,4,5,8,9 This particular strain of CDAD is more frequent, severe, resistant to standard therapy, and likely to relapse than any other present strain and it is believed that the high resistance of this strain reflects the overuse of cephalosporins and fluoroquinolones within the past several years. Although the bacterium that is responsible for CDAD has been around since 1978, these recent more virulent strains have resulted in a new interest in this “old pathogen.” 18 Successful management of CDAD requires early detection of infections, rapid treatment, and strict implementation of infection control policies and procedures. 3,17 According to the Society for Healthcare Epidemiology of America standard recommendations for infection control in CDAD infected patients include patient isolation in a single room, contact precautions, and the use of special bleach cleansers for cleaning purposes. The most important method of prevention, however, is hand washing using soap and water since alcohol-based sanitizers are unable to kill clostridia spores. 2 As this new CDAD epidemic grows it is important for researchers and practitioners to be aware of and understand the impact of CDAD within their healthcare settings.The objective of this study was to report the prevalence of Clostridium difficile associated disease among selected Diagnosis Related Groups and examine the impact this bacterium has on mortality rates, mean length of stay (LOS), and total patient costs at a large academic, community h