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Attributable Cost of Clostridium difficile Infection in Pediatric Patients

  • Preeti Mehrotra (a1), Jisun Jang (a2), Courtney Gidengil (a1) (a3) and Thomas J. Sandora (a1)

The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children.


We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score–matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost.


We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days.


Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost.

Infect Control Hosp Epidemiol 2017;38:1472–1477

Corresponding author
Address correspondence to Preeti Mehrotra, MD, Division of Infectious Diseases, Boston Children’s Hospital, 320 Longwood Avenue, Boston, MA 02115 (
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PREVIOUS PRESENTATION. This work was previously presented at the Society for Healthcare Epidemiology of America: Science Guiding Prevention 2015 conference in Orlando, Florida, on May 15, 2015.

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