S M Heimann1, J J Vehreschild2,3, O A Cornely2,3,4,5, H Wisplinghoff6, M Hallek2,5, R Goldbrunner5,7, B W Böttiger8, T Goeser5,9, A Hölscher5,10, S Baldus11, F Müller2, N Jazmati6, S Wingen8, B Franke2,3, M J G T Vehreschild12,13. 1. Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. sebastian.heimann@uk-koeln.de. 2. Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 3. German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany. 4. Clinical Trials Centre Cologne, ZKS Köln, BMBF01KN1106, and Cluster of Excellence, Cellular Stress Responses in Aging-Associated Diseases, CECAD, University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany. 5. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany. 6. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany. 7. Department of Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 8. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 9. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 10. Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 11. Department of Cardiology, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. 12. Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. maria.vehreschild@uk-koeln.de. 13. German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany. maria.vehreschild@uk-koeln.de.
Abstract
PURPOSE: Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown. METHODS: We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDAD patients without recurrence), recurrence group (CDAD patients with ≥1 recurrence) and control group (matched non-CDAD patients). RESULTS: Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30-37), 94 (95 %CI: 76-112) and 24 days (95 %CI: 22-27; P = <0.001), resulting in mean overall direct treatment costs per patient of €18,460 (95 %CI: €14,660-€22,270), €73,900 (95 %CI: €50,340-€97,460) and €14,530 (95 %CI: €11,730-€17,330; P = <0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10-12) and 36 (95 %CI: 27-45; P = <0.001). CONCLUSIONS: Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.
PURPOSE:Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown. METHODS: We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of NeutropenicPatients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDADpatients without recurrence), recurrence group (CDADpatients with ≥1 recurrence) and control group (matched non-CDADpatients). RESULTS: Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30-37), 94 (95 %CI: 76-112) and 24 days (95 %CI: 22-27; P = <0.001), resulting in mean overall direct treatment costs per patient of €18,460 (95 %CI: €14,660-€22,270), €73,900 (95 %CI: €50,340-€97,460) and €14,530 (95 %CI: €11,730-€17,330; P = <0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10-12) and 36 (95 %CI: 27-45; P = <0.001). CONCLUSIONS: Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.
Authors: L Sabau; A Meybeck; J Gois; P Devos; P Patoz; N Boussekey; P-Y Delannoy; A Chiche; H Georges; O Leroy Journal: Infection Date: 2013-06-19 Impact factor: 3.553
Authors: Konstantinos Z Vardakas; Konstantinos A Polyzos; Konstantina Patouni; Petros I Rafailidis; George Samonis; Matthew E Falagas Journal: Int J Antimicrob Agents Date: 2012-03-06 Impact factor: 5.283
Authors: M Guastalegname; S Grieco; S Giuliano; M Falcone; R Caccese; P Carfagna; M D'ambrosio; G Taliani; M Venditti Journal: Infection Date: 2014-02-13 Impact factor: 3.553
Authors: Oliver A Cornely; Mark A Miller; Bruno Fantin; Kathleen Mullane; Yin Kean; Sherwood Gorbach Journal: J Clin Oncol Date: 2013-05-28 Impact factor: 44.544
Authors: S M Heimann; O A Cornely; H Wisplinghoff; M Kochanek; D Stippel; S A Padosch; G Langebartels; H Reuter; M Reiner; A Vierzig; H Seifert; M J G T Vehreschild; J Glossmann; B Franke; J J Vehreschild Journal: Eur J Clin Microbiol Infect Dis Date: 2014-09-12 Impact factor: 3.267
Authors: Oliver A Cornely; Mark A Miller; Thomas J Louie; Derrick W Crook; Sherwood L Gorbach Journal: Clin Infect Dis Date: 2012-08 Impact factor: 9.079
Authors: Viola C Y Chow; Thomas N Y Kwong; Erica W M So; Yolanda I I Ho; Sunny H Wong; Raymond W M Lai; Raphael C Y Chan Journal: Sci Rep Date: 2017-12-08 Impact factor: 4.379
Authors: Vimalanand S Prabhu; Oliver A Cornely; Yoav Golan; Erik R Dubberke; Sebastian M Heimann; Mary E Hanson; Jane Liao; Alison Pedley; Mary Beth Dorr; Stephen Marcella Journal: Clin Infect Dis Date: 2017-10-01 Impact factor: 9.079