LISBON — Clostridium difficile-associated diarrhea contracted in the community is an underappreciated and costly problem, Judith A. O'Brien asserted at the 12th International Congress on Infectious Diseases.
Hospital-acquired C. difficile diarrhea grabs all the attention. But cases that originate while patients are living at home are a growing problem, probably caused by widespread use of proton pump inhibitors and other gastric acid suppressants along with liberal prescribing of broad-spectrum antibiotics, according to Ms. O'Brien, director of cost research at the Caro Research Institute, Concord, Mass.
She presented an analysis of hospital data that included all 9.3 million discharges during 2002 in the states of California, Florida, Maryland, Massachusetts, New Jersey, and Washington. Community-acquired C. difficile intestinal infection was the principal diagnosis in 10,860 cases. Among those cases, 95% of affected patients were living at home prior to hospitalization; the remainder lived in nursing homes or prisons.
Community-acquired C. difficile diarrhea was primarily a disease of the elderly. The mean age of affected individuals was 68 years; the median age was 75.
Overall, 72% of all the patients who were affected patients were admitted through the emergency department.
In-hospital mortality was 4.2%. Mean and median length of stay for all patients was 6.8 and 5 days, respectively.
In Massachusetts, the only state that had reliable ICU data, 9% of the patients spent time in an ICU, with an average ICU length of stay of 7.9 days.
The mean and median cost of a hospital stay for management of C. difficile diarrhea was $15,800 and $9,142, respectively, or collectively roughly $217 million in inpatient costs in 2002 in the six states.
However, these figures seriously underestimate the total costs of management of community-acquired C. difficile diarrhea.
The reason for that is that 41% of patients who were admitted from home required postdischarge follow-up home health care services or were sent to a subacute nursing facility, rehabilitation center, or other facility, Ms. O'Brien noted at the congress, which was sponsored by the International Society for Infectious Diseases.
The study was funded by an unrestricted grant from Genzyme Corp.