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Attributable Burden of Hospital-Onset Clostridium difficile Infection: A Propensity Score Matching Study

  • Ying P. Tabak (a1), Marya D. Zilberberg (a2), Richard S. Johannes (a1) (a3), Xiaowu Sun (a1) and L. Clifford McDonald (a4)...



To determine the attributable in-hospital mortality, length of stay (LOS), and cost of hospital-onset Clostridium difficile infection (HO-CDI).


Propensity score matching.


Six Pennsylvania hospitals (2 academic centers, 1 community teaching facility, and 3 community nonteaching facilities) contributing data to a clinical research database.


Adult inpatients between 2007 and 2008.


We defined HO-CDI in adult inpatients as a positive C. difficile toxin assay result from a specimen collected more than 48 hours after admission and more than 8 weeks following any previous positive result. We developed an HO-CDI propensity model and matched cases with noncases by propensity score at a 1 : 3 ratio. We further restricted matching within the same hospital, within the same principal disease group, and within a similar length of lead time from admission to onset of HO-CDI.


Among 77,257 discharges, 282 HO-CDI cases were identified. The propensity score-matched rate was 90%. Compared with matched noncases, HO-CDI patients had higher mortality (11.8% vs 7.3%; P<.05), longer LOS (median [interquartile range (IQR)], 12 [9–21] vs 11 [8–17] days; P< .01), and higher cost (median [IQR], $20,804 [$ll,059-$38,429] vs $16,634 [$9,413–$30,319]; P< .01). The attributable effect of HO-CDI was 4.5% (95% confidence interval [CI], 0.2%–8.7%; P<.05) for mortality, 2.3 days (95% CI, 0.9–3.8; P<.01) for LOS, and $6,117 (95% CI, $1,659–$10,574; P<.01) for cost.


Patients with HO-CDI incur additional attributable mortality, LOS, and cost burden compared with patients with similar primary clinical condition, exposure risk, lead time of hospitalization, and baseline characteristics.


Corresponding author

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A07, Atlanta, GA 30333 (


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