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Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective

  • Soline Leblanc (a1), Cécile Blein (a1), Antoine Andremont (a2) (a3) (a4), Pierre-Alain Bandinelli (a5) and Thibaut Galvain (a5)...



To describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspective


Burden of illness study


All acute-care hospitals in France


Data were extracted from the French national hospitalization database (PMSI) for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10 th revision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs.


Overall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262).


CDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs.

Infect Control Hosp Epidemiol 2017;38:906–911


Corresponding author

Address correspondence to Thibaut Galvain, Da Volterra, 172 rue de Charonne 75011 Paris, France (


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PREVIOUS PRESENTATION. The results of this study were presented during an oral communication at the Réunion Interdisciplinaire de Chimiothérapie Anti-infectieuse (RICAI) 2016 on December 13, 2016, in Paris, France.



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1. Martin, M, Zingg, W, Knoll, E, Wilson, C, Dettenkofer, M, Prohibit Study Group. National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review. J Hosp Infect 2014;87:212219.
2. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.
3. Lucado, J, Gould, C, Elixhauser, A. Clostridium Difficile Infections (CDI) in Hospital Stays, 2009. Rockville, MD: Agency for Healthcare Research and Quality website. Published 2012. Accessed December 22, 2016.
4. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825834.
5. Desai, K, Gupta, SB, Dubberke, ER, Prabhu, VS, Browne, C, Mast, TC. Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach. BMC Infect Dis 2016;16:303.
6. The White House. National Strategy for Combating Antibiotic Resistant Bacteria. Washington; 2014.
7. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals: 2011–2012. European Center for Disease Prevention and Control website. Published 2013. Accessed May 11, 2017.
8. Kuijper, EJ, Coignard, B, Tüll, P, ESCMID Study Group for Clostridium difficile, EU Member States, European Centre for Disease Prevention and Control. Emergence of Clostridium difficile–associated disease in North America and Europe. Clin Microbiol Infect 2006;12(Suppl 6):218.
9. Eckert, C, Coignard, B, Hebert, M, et al. Clinical and microbiological features of Clostridium difficile infections in France: the ICD-RAISIN 2009 national survey. Med Mal Infect 2013;43:6774.
10. Le Monnier, A, Duburcq, A, Zahar, J-R, et al. Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals. J Hosp Infect 2015;91:117122.
11. Buisson, G. Redressements du Programme de médicalisation des Systèmes d’Informations PMSI. Direction de la recherche, des études, de l’évaluation et des statistiques, DREES website. Published 2015. Accessed December 15, 2016.
12. Les systèmes d’information pour la santé publique. Haut conseil de la santé publique website. Published 2009. Accessed December 20, 2016.
13. Manuel des groupes homogènes de malades. Ministère des affaires sociales et de la santé website. Published 2016. Accessed December 15, 2016.
14. Girard, D, Antoine, D, Che, D. Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information? Médecine Mal Infect 2014;44:509514.
15. Pierron, A, Revert, M, Goueslard, K, et al. Évaluation de la qualité métrologique des données du programme de médicalisation du système d’information (PMSI) en périnatalité: étude pilote réalisée dans 3 CHU. Rev Dépidémiologie Santé Publique 2015;63:237246.
16. Bernier, M-O, Mezzarobba, M, Maupu, E, et al. Utilisation des données du programme de médicalisation des systèmes d’information (PMSI) dans les études épidémiologiques: application à la Cohorte Enfant Scanner. Rev Dépidémiologie Santé Publique 2012;60:363370.
17. Boudemaghe, T, Belhadj, I. Data resource profile: the French National Uniform Hospital Discharge Data Set Database (PMSI). Int J Epidemiol February 2017. doi: 10.1093/ije/dyw359.
18. French guidelines for the economic evaluation of health care technologies. Collège des Economites de la Santé website. Published 2004. Accessed October 28, 2016.
19. Department of Economics and Public Health Assessment. Choices in methods for economic evaluation. Haute Autorité Santé website. Published 2012. Accessed October 28, 2016.
20. Or, Z. Implementation of DRG payment in France: issues and recent developments. Health Policy Amst Neth 2014;117:146150.
21. Eckert, C, Coignard, B, Hebert, M, et al. Clinical and microbiological features of Clostridium difficile infections in France: The ICD-RAISIN 2009 national survey. Médecine Mal Infect 2013;43:6774.
22. Crobach, MJT, Planche, T, Eckert, C, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect 2016;22(Suppl 4):S63S81.
23. Davies, KA, Longshaw, CM, Davis, GL, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis 2014;14:12081219.
24. Jones, G, Taright, N, Boelle, PY, et al. Accuracy of ICD-10 codes for surveillance of Clostridium difficile infections, France. Emerg Infect Dis 2012;18:979981.
25. Dubberke, E, Reske, K, McDonald, LC, Fraser, V. ICD-9 codes and surveillance for Clostridium difficile–associated disease. Emerg Infect Dis 2006;12:15761579.
26. Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262268.
27. Scheurer, DB, Hicks, LS, Cook, EF, Schnipper, JL. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiol Infect 2007;135:10101013.
28. Lyytikäinen, O, Turunen, H, Sund, R, et al. Hospitalizations and deaths associated with Clostridium difficile infection, Finland, 1996–2004. Emerg Infect Dis 2009;15:761765.
29. Miller, AC, Polgreen, LA, Cavanaugh, JE, Polgreen, PM. Hospital Clostridium difficile infection rates and prediction of length of stay in patients without C. difficile infection. Infect Control Hosp Epidemiol 2016;37:404410.
30. Magalini, S, Pepe, G, Panunzi, S, Spada, PL, De Gaetano, A, Gui, D. An economic evaluation of Clostridium difficile infection management in an Italian hospital environment. Eur Rev Med Pharmacol Sci 2012;16:21362141.
31. Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:2330.
32. Vonberg, R-P, Reichardt, C, Behnke, M, Schwab, F, Zindler, S, Gastmeier, P. Costs of nosocomial Clostridium difficile-associated diarrhoea. J Hosp Infect 2008;70:1520.
33. Ivarsson, ME, Leroux, J-C, Castagner, B. Investigational new treatments for Clostridium difficile infection. Drug Discov Today 2015;20:602608.
34. McFarland, LV. Therapies on the horizon for Clostridium difficile infections. Expert Opin Investig Drugs 2016;25:541555.
35. Leal, JR, Heitman, SJ, Conly, JM, Henderson, EA, Manns, BJ. Cost-effectiveness analysis of the use of probiotics for the prevention of Clostridium difficile–associated diarrhea in a provincial healthcare system. Infect Control Hosp Epidemiol 2016;37:10791086.

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Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective

  • Soline Leblanc (a1), Cécile Blein (a1), Antoine Andremont (a2) (a3) (a4), Pierre-Alain Bandinelli (a5) and Thibaut Galvain (a5)...


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