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Comparative Study
. 2012 Jan 10;184(1):37-42.
doi: 10.1503/cmaj.110543. Epub 2011 Dec 5.

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Alan J Forster  1 , Monica Taljaard, Natalie Oake, Kumanan Wilson, Virginia Roth, Carl van Walraven
Affiliations
Comparative Study

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Alan J Forster et al. CMAJ. .

Abstract

Background: The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital is not yet fully understood. We determined the independent impact of hospital-acquired infection with C. difficile on length of stay in hospital.

Methods: We conducted a retrospective observational cohort study of admissions to hospital between July 1, 2002, and Mar. 31, 2009, at a single academic hospital. We measured the association between infection with hospital-acquired C. difficile and time to discharge from hospital using Kaplan-Meier methods and a Cox multivariable proportional hazards regression model. We controlled for baseline risk of death and accounted for C. difficile as a time-varying effect.

Results: Hospital-acquired infection with C. difficile was identified in 1393 of 136,877 admissions to hospital (overall risk 1.02%, 95% confidence interval [CI] 0.97%-1.06%). The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI 0.39-0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI 0.32-0.58) for those in the highest decile; for discharge by day 28, the corresponding hazard ratios were 0.74 (95% CI 0.60-0.87) and 0.61 (95% CI 0.53-0.68).

Interpretation: Hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death.

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Figures

Figure 1:
Figure 1:
(A) Kaplan–Meier curves for crude and adjusted length of stay in hospital for patients with and without infection with Clostridium difficile. (B) Kaplan–Meier curves for length of stay in hospital for patients with and without infection with C. difficile, accounting for C. difficile as a time-varying covariable. (C) Kaplan–Meier curves for length of stay in hospital for patients with and without infection with C. difficile and “low” (first decile) versus “high” (tenth decile) baseline risk of death, accounting for C. difficile as a time-varying covariable.
Figure 2:
Figure 2:
Adjusted hazard ratios for discharge from hospital associated with hospital-acquired infection with Clostridium difficile as a function of time and baseline risk of mortality. Low risk corresponds to the 10th percentile of risk, median risk to the 50th percentile and high risk to the 90th percentile.
See this image and copyright information in PMC

Comment in

References

    1. Song X, Bartlett JG, Speck KA, et al. Rising economic impact of Clostridium difficile-associated disease in adult hospitalized patient population. Infect Control Hosp Epidemiol 2008;29:823–8 - PubMed
    1. Pépin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005; 173:1037–42 - PMC - PubMed
    1. Oake N, Taljaard M, van Walraven C, et al. The effect of hospital-acquired Clostridium difficile infection on in-hospital mortality. Arch Intern Med 2010;170:1804–10 - PubMed
    1. Ghantoji SS, Sail K, Lairson DR, et al. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 2010;74:309–18 - PubMed
    1. Riley TV, Codde JP, Rouse IL. Increased length of hospital stay due to Clostridium difficile associated diarrhoea. Lancet 1995; 345:455–6 - PubMed

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