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Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

  • Xiaoyan Song (a1), John G Bartlett (a1), Kathleen Speck (a1), April Naegeli (a2), Karen Carroll (a1) and Trish M. Perl (a1)...



Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.


To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.


A retrospective matched cohort study.


Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.


Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.


The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.


There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.


Corresponding author

The Children's National Medical Center, Suite W3.5-100, 111 Michigan Avenue, NW, Washington, DC 20010 (


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