Background
Methods
Search strategy
Study selection
Data extraction
Meta-analysis and estimation of national impact
Sensitivity analysis
Quality assessment
Results
Search results
Study characteristics
ID | Reference | State, city | Data collection period | Type of CDI | Population | Sample size (Total) | Sample size (CDI cases) | Age of CDI patients Mean ± SD or (Range), years | CDI definition (short) | Quality assessment | Statistical methodology | Data source |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Ali 2012 [27] | National | 2004–2008 | Comp. | Liver transplant | 193,714 | 5159 | >18 | ICD-9; 008.45 (Primary Diagnosis-PD, Secondary Diagnosis-SD) | Low | No matching; no regression | Nationwide Inpatient Sample (NIS) |
2 | Ananthakrishnan 2008 [28] | National | 2003 | Comp. | IBD | 124,570 | 2804 | >18 CDI: 73a; CDI-IBD: 54a | ICD-9; 008.45 (PD) | Medium | No matching; regression | NIS |
3 | Arora 2011 [29] | Houston | 2007–2008 | Req. | General | 85 | 85 | Horn’s Index Score 1&2: 64 ± 19; Horn’s Index Score 3&4: 65 ± 15 | Toxin assay | Low | No matching; no regression | St Luke’s Episcopal Hospital |
4 | Bajaj 2010 [30] | National | National: 2005 Tertiary: 2002–2006 | Both | Cirrhosis | 83,230 | 1165 | CDI: 69 ± 20; Cirrhosis-CDI: 61 ± 15 | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
5 | Campbell 2013 [31] | National | 2005–2011 | Comp. | General | NR | 4521 | Renal impairment 72.9 ± 13.4; Advanced Age: 78.7 ± 7.4; Cancer/BMT 69.2 ± 14.0; IBD 61.2 ± 18.3; Cabx exposure 61.2 ± 14.8 | Toxin assay | High | Matching; regression | Health Facts electronic health record (HER) database |
6 | Damle 2014 [14] | National | 2008–2012 | Comp. | Colorectal surgery | 84,648 | 1266 | >18 63 ± 17 | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | University Health System Consortium database |
7 | Dubberke 2008 [33] | Missouri | 2003–2003 | Both | Non- Surgical | 24,691 | 439 | 67(18–101) a | Toxin assay | High | Matching; regression | Barnes-Jewish Hospital Electronic record |
8 | Missouri | 2003–2009 | Both | Recurrent CDI | 3958 | 421 | >18 | Toxin assay or clinical diagnosis for recurrent CDI | High | Matching; regression | Barnes-Jewish Hospital Electronic record | |
9 | Egorova 2015 [35] | National | 2000–2011 | Comp. | Vascular surgery | NR | 2808 | 68.4 | ICD-9; 008.45 (PD, SD) | High | Matching: regression | NIS |
10 | Flagg 2014 [36] | National | 2004–2008 | Comp. | Cardiac surgery | 349,112 | 2581 | All age band | ICD-9; 008.45 (SD) | High | Matching: regression | NIS |
11 | Fuller 2009 [37] | Maryland and California | 2007–2008 for Maryland 2005–2006 for California | Comp. | General | 3760 | 3760 | – | Clinical diagnosis | Medium | No matching; regression | Health Services and Cost Review Commission, Maryland; The Office of State-wide Planning and Development, California |
12 | Glance 2011 [38] | National | 2005–2006 | Comp. | Trauma | 149,648 | 768 | 69(45–82) a | Clinical diagnosis | Medium | No matching; regression | NIS |
13 | Jiang 2013 [39] | Rhode Islands | 2010–2011 | Comp. | General | 225,999 | 6053 | >18 71.4 ± 15.8 | ICD-9; 008.45 (SD) | Medium | Matching; no regression | Rhode Island’s 11 acute-care hospitals |
14 | Kim 2012 [40] | National | 2001–2008 | Comp. | Cystectomy | 10,856 | 153 | >18 68.49 ± 10.52 | ICD-9 ; 008.45 (SD) | Medium | No matching; regression | NIS |
15 | Kuntz 2012 [41] | Colorado | 2005–2008 | Comp. | General | 3067 | 3067 | All age band, Outpatient 62.8 ± 19.4; Inpatient 69.9 ± 16.3 | ICD-9 + toxin assay | Medium | No matching; regression | Kaiser Permanente Colorado and Kaiser Permanente Northwest members |
16 | Lagu 2014 [42] | Massachusetts, Boston one hospital | 2004–2010 | Comp. | Sepsis | 218,915 | 2348 | 70.9 ± 15.1 | ICD-9; 008.45 (PD, SD) + toxin assay | Medium | Matching; no regression | Baystate Medical Center (Premier Healthcare Informatics database, a voluntary, fee-supported database) |
17 | Lameire 2015 | National | 2002–2009 | Comp. | Cardiac surgery | 512,217 | 421,294 | >40 CABG 65.4 ± 10.5 VS 66.1 ± 12.3 | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
18 | Lawrence 2007 [44] | Missouri | 1997–1999 | Both | ICU | 1872 | 76 | Primary 68.9 (34–93) Secondary 58.7 (16–91) | Toxin assay | Medium | No matching; regression | A 19-bed medical ICU in a Midwestern tertiary care referral center. |
19 | Lesperance 2011 [45] | National | 2004–2006 | Comp. | Elective colonic resections | 695,010 | 10,077 | >18 All 69.8; Surgery-CDI 68.7 | ICD-9; 008.45 (SD) | Medium | No matching; regression | NIS |
20 | Lipp 2012 [46] | New York | 2007–2008 | Comp. | General | 4,853,800 | 3883 | >17 | ICD-9; 008.45 (SD) | Medium | No matching; regression | - The SPARCS database- acute care non-federal hospitals in New York State |
21 | Maltenfort 2013 [47] | National | 2002–2010 | Both | Arthroplasty | NR | NR | All age band | ICD-9; 008.45 (PD, SD) | Low | No matching; no regression | NIS |
22 | McGlone 2012 [48] | National | 2008 | Comp. | General | NR | NR | >65 | ICD-9; 008.45 (SD) | Low | No matching; no regression | Decision tree model |
23 | Nguyen 2008 [49] | National | 1998–2004 | Comp. | IBD | 527,187 | 2372 | 47.4 ± 0.2 | ICD-9; 008.45 (secondary diagnosis) | Medium | No matching; regression | NIS |
24 | Nylund 2011 [50] | National | 1997,2000, 2003,2006 | Both | Children | 10,495,728 | 21,274 | CDI 9.5 ± 0.07(SEM) | ICD-9; 008.45 (PD, SD) | High | Matching: regression | Healthcare Cost and Utilization Project Kids’Inpatient Database |
25 | O’Brien 2007 [51] | Massachusetts | 1999–2003 | Req. | General | 3692 | 1036 | Primary 70 ± 17.6; Secondary 70 ± 17.2 | ICD-9; 008.45 (PD, SD) | Low | No matching; no regression | Massachusetts hospital discharge data |
26 | Pakyz 2011 [52] | National | 2002–2007 | Comp. | General | 30,071 | 10,857 | CDI 61 ± 17 | ICD-9; 008.45 (SD) | High | Matching; regression | University Health System Consorsoum (UHC) |
27 | Pant 2012 [53] | National | 2009 | Both | Organ transplant (OT) | 244,955 | 6451 | >18, OT-CDI 58 ± 16 a; CDI-only 73 ± 22 a | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
28 | Pant 2012 (2) [54] | National | 2009 | Both | Renal disease | 184,139 | 5151 | >18, ESRD + CDI 66 ± 14 CDI ONLY 70 ± 17 | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
29 | Pant 2013 [55] | National | 2009 | Both | Children with IBD | 12,610 | 447 | <20, 15.1 ± 4.1 | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | The Healthcare Cost and Utilization Project Kids’ Inpatient Database (HCUP-KID) |
30 | Peery 2012 [56] | National | From 2009 | Req. | General | 110,533 | 110,533 | All age band | ICD-9; 008.45 (PD) | Low | No matching; no regression | National Ambulatory Medical Care Survey (NAMCS) and NIS |
31 | Quimbo 2013 [57] | National | 2005–2010 | Comp. | High Risk subgroups | 21,177 | 26,620 | >18 67.5 ± 17.6 | ICD-9; 008.45 (PD, SD) | High | Matching: regression | HealthCare Integrated Research Database |
32 | Reed 2008 | Pennsylvania | 2002–2006 | Comp. | High Risk subgroups | 9164 | 524 | >17 | Hospital acquired CDAD | Low | No matching; no regression | A large academic community hospital |
33 | Sammons 2013 [59] | National | 2006–2011 | Both | Children | 13,295 | 4447 | 1–18 6 (2–13) a | ICD-9; 008.45 (PD, SD) + toxin assay | High | Matching; regression | Free-standing children’s hospitals via the Paediatric Health Information System (PHIS) |
34 | Singal 2014 [60] | National | 2007 | Comp. | Cirrhosis | 89,673 | 1444 | All age band | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
35 | Song 2008 [61] | Maryland | 2000–2005 | Both | General | 9025 | 630 | >18 unmatched 57.6 matched 60.3 | Toxin assay | High | Matching; regression | The Johns Hopkins hospital |
36 | Stewart 2011 [62] | National | 2007 | Both | General | 82,214 | 41,207 | All age band, 70 | ICD-9; 008.45 (PD, SD) | Medium | Matching; no regression | NIS |
37 | Tabak 2013 [63] | Pennsylvania | 2007–2008 | Comp. | General | 77,257 | 255 | All 64.8 ± 17.6 CDI 71.1 ± 14.8 | Toxin assay | High | Matching; regression | Six Pennsylvania hospitals via a clinical research database |
38 | VerLee 2012 | Michigan | 2002–2008 | Req. | General | 517,413 | 517,413 | All age band | ICD-9; 008.45 (PD) | Low | No matching; no regression | All Michigan acute care hospitals |
39 | Wang 2011 [65] | Pennsylvania | 2005–2008 | Both | General | 7,227,788 | 78,273 | All age band | ICD-9; 008.45 (PD, SD) | High | Matching; regression | The Pennsylvania Health Care Cost Containment Council (PHC4) database |
40 | Wilson 2013 [66] | National | 2004–2008 | Comp. | Ileostomy | 13,245 | 217 | All age band | ICD-9; 008.45 (SD) | High | Matching; regression | NIS |
41 | Zerey 2007 [67] | National | 1999–2003 | Both | Surgical | 1,553,597 | 8113 | All age band 70 am | ICD-9; 008.45 (PD, SD) | Medium | No matching; regression | NIS |
42 | Zilberberg 2009 [68] | National | 2005 | Both | Prolonged acute mechanical ventilation | 64,910 | 3468 | >18 66.7 ± 15.9 | ICD-9; 008.45 (PD, SD) | Medium | Matching; no regression | NIS |
Case definition | Criteria for classification |
---|---|
CO-CDI | - Discharge code ICD-9-CM 008.45 as Primary diagnosis |
HO-CDI | - Discharge code ICD-9-CM 008.45 as secondary diagnosis, without a primary diagnosis of a CDI-related symptom (e.g. diarrhea) - Study population ≥ 48 h of hospitalization - Symptom onset and/or positive laboratory assay at least ≥ 48 h hospitalization |
Both CDI | - No distinction of settings of acquisition - Discharge code ICD-9-CM 008.45 in any position |
CDI costs and LOS
Author, Year | Population | Outcome | Statistic | Incremental CDI-attributable cost/charges | CDI-related cost/charges | Note | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Sample size | Attributable cost 2015$ | SD or 95 % CI | Sample size | CDI only cost 2015$ | SD, 95 % CI or IQR | |||||||
CO-CDI Inpatient Cost | ||||||||||||
Arora 2011 [29] | General | Cost | Median | 85 | 25,436 | 85 | 25,436 | |||||
O’Brien 2007 [51] | General | Cost | Mean | 4015 | 14,736 | 4015 | 14,736 | |||||
Peery 2012 [56] | General | Cost | Median | 110,553 | 7513 | 110,553 | 7513 | |||||
VeerLee 2012 [64] | General | Charges | Mean | 68,686 | 74,211 | 120,156 | 68,686 | 74,211 | 120,156 | |||
Kuntz 2012 [41] | General | Cost | Mean | 1650 | 929 | 4800 | 1650 | 929 | 4800 | Outpatient | ||
Kuntz 2012 [41] | General | Cost | Mean | 1316 | 11,877 | 35,923 | 1316 | 11,877 | 35,923 | Inpatient | ||
O’Brien 2007 [51] | General | Cost | Median | 1036 | 7263 | 1036 | 7263 | PD | ||||
VeerLee 2012 [64] | General | Charges | Mean | 17,413 | 27,463 | 40,484 | 17,413 | 27,463 | 40,484 | PD | ||
O’Brien 2007 [51] | General | Cost | Mean | 3327 | 16,946 | 34,655 | 3327 | 16,946 | Rehospitalisation | |||
Sammons 2013 [59] | Children | Cost | Mean | 2060 | 19,993 | 15,973 | 24,013 | 2060 | 19,993 | 15,973 | 24,013 | Community onset |
Ananthakrishnan 2008 [28] | IBD | Charges | Median | 44,400 | 16,864 | CDI only | ||||||
Pant 2013 [55] | IBD | Charges | Mean | 12,610 | 12,761 | 6868 | 18,655 | 447 | 50,050 | CDI only | ||
Bajaj 2010 [30] | Cirrhosis | Charges | Mean | 58,220 | 70,309 | CDI only | ||||||
Quimbo 2013 [57] | CDI History | Cost | Mean | 1866 | 29,662 | 20,798 | 42,300 | 933 | 51,863 | 36,641 | 73,411 | CDI only |
Total numbers/Weighted Mean | 224,617 | 20,085 | 314,141 | 23,322 | ||||||||
HO-CDI Inpatient Cost | ||||||||||||
Fuller 2009 [37] | General | Cost | Coefficient | 1282 | 18,466 | 288 | 1282 | 18,466 | 288 | Maryland, SD | ||
Fuller 2009 [37] | General | Cost | Coefficient | 2478 | 29,980 | 271 | 2478 | 29,980 | 271 | California, SD | ||
Lipp 2012 [46] | General | Cost | Mean | 3826 | 32,050 | 3826 | 32,050 | SD | ||||
McGlone 2012 [48] | General | Cost | Median | 54,046 | 10,016 | 8547 | 12,055 | 54,046 | 10,016 | 8547 | 12,055 | SD Cost-hospital perspective-6 days LOS |
McGlone 2012 [48] | General | Cost | Median | 54,046 | 11,116 | 9476 | 13,366 | 54,046 | 11,116 | 9476 | 13,366 | 10 days LOS |
McGlone 2012 [48] | General | Cost | Median | 54,046 | 12,194 | 10,146 | 14,896 | 54,046 | 12,194 | 10,146 | 14,896 | 14 days LOS |
O’Brien 2007 [51] | General | Cost | Median | 2656 | 6630 | 2656 | 6630 | SD | ||||
VeerLee 2012 [64] | General | Charges | Mean | 51,273 | 90,202 | 146,767 | 51,273 | 90,202 | 146,767 | SD | ||
Jiang 2013 [39] | General | Cost | Median | 7264 |
11,689
| 1211 | 21,751 | |||||
Pakyz 2011 [52] | General | Cost | Mean | 30,071 |
31,180
| 10,857 | 64,732 | Unadjusted | ||||
Pakyz 2011 [52] | General | Cost | Median | 30,071 |
24,456
| 10,857 | 39,598 | 22,400 | 88,537 | Unadjusted | ||
Pakyz 2011 [52] | General | Cost | Mean | 30,071 |
31,169
| 10,857 | 64,000 | 63,541 | 64,458 | Adjusted | ||
Tabak 2013 [63] | General | Cost | Mean | 1020 | 6893 | 1365 | 13,617 | 255 | 22,992 | 12,222 | 42,470 | |
Campbell 2013 [31] | Age > = 65 | Cost | Mean | 3064 | 7536 | 4302 | 10,771 | 3064 | 48,932 | 67,727 | ||
Quimbo 2013 [57] | Elderly | Cost | Mean | 34,732 | 45,749 | 43,279 | 48,359 | 10,933 | 83,004 | 78,548 | 87,713 | |
Sammons 2013 [59] | Children | Cost | Mean | 2414 | 99,012 | 84,626 | 113,398 | 2414 | 99,012 | 84,626 | 113,398 | |
Ananthakrishnan 2008 [28] | IBD | Charges | Median | 80,170 |
7655
| 2804 | 24,623 | |||||
Ananthakrishnan 2008 [28] | IBD | Charges | Mean | 80,170 | 14,368 | 9467 | 19,270 | – | ||||
Campbell 2013 [31] | IBD | Cost | Mean | 84 | 1522 | −14,932 | 11,888 | 84 | 40,194 | 44,845 | ||
Quimbo 2013 [57] | IBD | cost | Mean | 3618 | 11,825 | 9851 | 14,181 | 1206 | 42,035 | 35,918 | 49,191 | |
Ananthakrishnan 2008 [28] | Ulcerative colitis (UC) | Charges | Median | 1843 | 26,750 | |||||||
Nguyen 2008 [49] | UC | Charges | Mean | 43,645 |
14,749
| 196 | 43,381 | Regression | ||||
Ananthakrishnan 2008 [28] | Crohn's disease (CD) | Charges | Median | 961 | 22,738 | |||||||
Nguyen 2008 [49] | CD | Charges | Mean | 73,197 |
14,316
| 329 | 41,453 | Regression | ||||
Reed 2008 | Digestive disorders | Charges | Mean | 2394 |
3670
| 320 | 9076 | 8068 | ||||
Damle 2014 [14] | Colorectal surgery | Cost | Median | 84,648 | 14,644 | 13,700 | 15,589 | 1266 | 21,309 | 38,218 | – | |
Kim 2012 [40] | Cystectomy | Cost | Mean | 10,856 |
25,014
| 153 | 57,379 | 50,204 | 64,554 | |||
Lesperance 2011 [45] | Elective colonic resection | Charges | Mean | 695,010 |
84,899
| 10,077 | 158,401 | |||||
Reed 2008 | Major bowel procedures | Charges | Mean | 1035 |
25,476
| 45 | 47,064 | 31,302 | ||||
Wilson 2013 [66] | Ileostomy | Cost | Mean | 13,462 |
20,272
| 217 | 35,076 | |||||
Wilson 2013 [66] | Ileostomy | Cost | Coefficient | 13,462 | 17,513 | 14,106 | 20,921 | |||||
Egorova 2015 [35] | Vascular surgery | Cost | Median | 450,251 | 14,250 | 4708 | 36,847 | 22,912 | 62,903 | |||
Flagg 2014 [36] | Cardiac surgery | Cost | Median | 5160 |
19,524
| 2580 | 213,661 | Adjusted | ||||
Flagg 2014 [36] | Cardiac surgery | Cost | Median | 349,122 |
38,320
| 2580 | 72,730 | Unadjusted | ||||
Lemaire 2015 [43] | Cardiac surgery | Cost | Median | 421,294 |
35,968
| – | 72,685 | CABG | ||||
Lemaire 2015 [43] | Cardiac surgery | Cost | Median | 90,923 |
59,696
| – | 106,141 | VS | ||||
Reed 2008 | OR procedure for infectious /parasitic diseases | Charges | Mean | 449 |
7462
| 32 | 35,524 | 25,498 | ||||
Glance 2011 [38] | Trauma | Cost | Median | 149,656 |
24,131
| 768 | 39,296 | |||||
Campbell 2013 [31] | Cabx | Cost | Mean | 1641 | 18,567 | 10,448 | 26,687 | 1641 | 78,948 | 99,739 | ||
Quimbo 2013 [57] | Cabx | Cost | Mean | 17,716 | 38,413 | 35,195 | 41,922 | 4429 | 64,242 | 59,145 | 69,780 | |
Lagu 2014 [42] | Sepsis | Cost | Median | 4736 | 5792 | 4933 | 6665 | 2368 | 28,576 | 16,496 | 50,494 | |
Reed 2008 | Septicaemia | Charges | Mean | 1211 |
9141
| 92 | 22,378 | 20,591 | ||||
Campbell 2013 [31] | Renal impairment | Cost | Mean | 3236 | 5024 | 1118 | 8928 | 3236 | 50,586 | 72,180 | ||
Quimbo 2013 [57] | RI | Cost | Mean | 22,132 | 122,318 | 111,315 | 134,405 | 5533 | 201,212 | 183,706 | 220,386 | |
Ali 2012 [27] | Liver transplant | Charges | Mean | 193,714 |
77,361
| 5159 | 158,038 | |||||
Singal 2014 [60] | Cirrhosis | Charges | Mean | 89,673 |
23,310
| 1444 | 47,401 | |||||
Reed 2008 | Congestive Heart Failure | Charges | Mean | 2542 |
7332
| 35 | 14,738 | 13,841 | ||||
Quimbo 2013 [57] | Immunocompromised | Cost | Mean | 14,344 | 33,632 | 30,151 | 37,516 | 3586 | 73,612 | 66,048 | 82,041 | |
Campbell 2013 [31] | Cancer/BMT | Cost | Mean | 782 | 687 | −6480 | 7855 | 782 | 48,280 | 72,605 | ||
Total numbers/Weighted mean | 3,020,827 | 34,149 | 207,801 | 49,712 | ||||||||
Recurrent CDI | Cost | Mean | 3958 | 12,163 | 3958 | 11,523 | 4728 | 26,167 | Total cost difference | |||
Recurrent CDI | Cost | Mean | 3958 | 12,692 | 9752 | 15,919 | Adjusted | |||||
Song 2008 [61] | General | Cost | Median | 1260 |
373
| 630 | 30,305 | |||||
Stewart 2011 [62] | General | Cost | Mean | 82,414 |
9670
| 41,207 | 26,790 | |||||
Wang 2011 [65] | General | Cost | Median | 7,227,788 |
4914
| 78,273 | 12,081 | |||||
Nylund 2011 [50] | Children | Charges | Median | 3565 |
15,937
| 3565 | 25,549 | 1997 | ||||
Nylund 2011 [50] | Children | Charges | Median | 4356 |
20,750
| 4356 | 31,858 | 2000 | ||||
Nylund 2011 [50] | Children | Charges | Median | 5574 |
23,627
| 5574 | 33,625 | 11,348 | 97,822 | 2003 | ||
Nylund 2011 [50] | Children | Charges | Median | 7779 |
23,362
| 7779 | 35,444 | 13,601 | 110,343 | 2006 | ||
Sammons 2013 [59] | Children | Cost | Mean | 698,616 | 51,304 | 44,746 | 57,969 | 698,616 | 51,304 | 44,746 | 57,969 | |
Dubberke 2008 [33] | Non-surgical | Cost | Median | 24,691 |
11,749
| 439 | 20,569 | Raw data | ||||
Dubberke 2008 [33] | Non-surgical | Charges | Median | 24,691 |
23,961
| 439 | 42,154 | Raw data | ||||
Dubberke 2008 [33] | Non-surgical | Cost | Mean | 24,691 | 3173 | 3078 | 3815 | Linear regression | ||||
Dubberke 2008 [33] | Non-surgical | Cost | Median | 24,691 | 4190 | 342 | 18,842 | Matched cases | ||||
Dubberke 2008 [33] | Non-surgical | Cost | Mean | 24,691 | 6520 | 4910 | 8381 | Linear regression, 180 days | ||||
Dubberke 2008 [33] | Non-surgical | Cost | Median | 24,691 | 9284 | 342 | 35,414 | Matched cases, 180 days | ||||
Zerey 2007 [67] | Surgical | Charges | Median | 1,553,597 |
59,424
| 8113 | 81,708 | |||||
Zerey 2007 [67] | Surgical | Charges | Coefficient | 1,553,597 | 94,402 | 91,589 | 97,216 | Multivariate regression analysis | ||||
Zilberberg 2009 [68] | Prolonged acute mechanical ventilation (PAMV) | Cost | Median | 64,910 |
48,065
| 3468 | 190,188 | 107,689 | 333,290 | Unadjusted | ||
Zilberberg 2009 [68] | PAMV | Cost | Mean | 3370 | 12,616 | 9186 | 16,046 | 3468 | 91,039 | 71,306 | Adjusted | |
Lawrence 2007 [44] | ICU | Cost | Median | 1872 |
7043
| 76 | 15,016 | ICU stay | ||||
Lawrence 2007 [44] | ICU | Cost | Median | 1872 |
36,095
| 76 | 60,723 | Entire hospital stay | ||||
Bajaj 2010 [30] | Cirrhosis | Charges | Mean | 83,230 | 49,460 | 1165 | 96,678 | |||||
Maltenfort 2013 [47] | Arthroplasty | Charges | Median | – | 43,648 | – | 84,877 | 52,498 | 142,827 | |||
Pant 2012 [53] | Organ transplant | Charges | Mean | 49,198 | 77,246 | 73,412 | 81,080 | 63,651 | 42,054 | 69,033 | ||
Pant 2012 (2) [54] | Renal disease | Charges | Coefficient | 184,139 | 69,679 | 68,338 | 71,020 | 59,793 | 87,982 | |||
Pant 2013 [55] | IBD | Charges | Mean | 12,610 | 39,453 | 32,470 | 46,436 | |||||
Total numbers/Weighted Mean | 10,012,927 | 14,403 | 981,005 | 45,421 |
Reference | Population | Statistic | CDI VS NO CDI LOS (Days) | CDI LOS (Days) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Sample size | Value | SD or 95 % CI | Sample size | Value | SD or 95 % CI | |||||
CO-CDI Inpatient days | ||||||||||
Arora 2011 [29] | Horn’s index 1&2 | Mean | 33 | 15.1 | 16.2 | 33 | 15.1 | 16.2 | ||
Arora 2011 [29] | Horn’s index 3&4 | Mean | 52 | 33.4 | 33.3 | 52 | 33.4 | 33.3 | ||
Kuntz 2012 [41] | General outpatient | Mean | 1650 | 10.0 | 17.0 | 1650 | 10.0 | 17.0 | ||
Kuntz 2012 [41] | General inpatient | Mean | 1316 | 14.9 | 20.9 | 1316 | 14.9 | 20.9 | ||
O’Brien 2007 [51] | General | Mean | 4015 | 6.4 | 4015 | 6.4 | ||||
Pant 2013 [55] | IBD | Coefficient | 12,610 | 2.1 | 1.4 | 2.8 | 2.1 | 1.4 | 2.8 | |
Peery 2012 [56] | General | Median | 110,553 | 5.0 | 110,553 | 5.0 | ||||
Quimbo 2013 [57] | CDAD History | Mean | 1866 | 2.9 | 2.4 | 3.6 | 933 | 8.9 | 7.2 | 11.0 |
Sammons 2013 [59] | Children | Median | 2060 | 5.6 | 4.5 | 6.6 | 2060 | 6.0 | 4.0a | 13.0a |
VeerLee 2012 [64] | General | Mean | 68,686 | 7.1 | 7.0 | 68,686 | 7.1 | 7.0 | ||
Weighted Mean | 202,841 | 5.7 | 189,298 | 5.9 | ||||||
HO-CDI inpatient days | ||||||||||
Jiang 2013 [39] | General | Median | 7264 |
8.0
| 1211 | 13.0 | ||||
Lipp 2012 [46] | General | Mean | 3826 | 12.0 | 3826 | 12.0 | ||||
Pakyz 2011 [52] | General | Mean | 30,071 | 11.1 | 10,857 | 21.1 | 21.0 | 21.2 | ||
Tabak 2013 [63] | General | Median | 1020 | 2.3 | 0.9 | 3.8 | 255 | 12.0 | 9.0a | 21.0a |
Wang 2013 | General | Median | 7,227,788 |
7.0
| 78,273 | 6.0 | 4.0a | 11.0a | ||
Campbell 2013 [31] | Age > = 65 | Mean | 3064 | 3.0 | 1.4 | 4.6 | 3064 | 21.3 | 25.3 | |
Quimbo 2013 [57] | Elderly | Mean | 34,732 | 7.8 | 7.5 | 8.1 | 10,933 | 18.8 | 18.2 | 19.5 |
Sammons 2013 [59] | Children | Median | 2414 | 21.6 | 19.3 | 23.9 | 2414 | 23.0 | 12.0a | 44.0a |
Ananthakrishnan 2008 [28] | IBD | Median | 80,170 | 3.0 | 2804 | 7.0 | ||||
Campbell 2013 [31] | IBD | Mean | 84 | 3.0 | −2.3 | 8.3 | 84 | 21.0 | 19.1 | |
Quimbo 2013 [57] | IBD | Mean | 3618 | 3.3 | 2.9 | 3.7 | 1206 | 12.8 | 11.6 | 14.2 |
Nguyen 2008 [49] | Crohn’s disease | Mean | 73,197 |
3.8
| 329 | 9.5 | ||||
Nguyen 2008 [49] | Ulcerative colitis | Mean | 43,645 |
3.2
| 196 | 9.9 | ||||
Reed 2008 | Digestive disorders | Mean | 2394 |
3.0
| 320 | 6.9 | 5.2 | |||
Damle 2014 [14] | Colorectal surgery | Median | 84,648 | 8.4 | 8.0 | 8.9 | 1266 | 13.0 | 18.0 | |
Lesperance 2011 [45] | Elective colonic resection | Mean | 695,010 |
11.7
| 10,077 | 22.6 | ||||
Reed 2008 | Major bowel procedures | Mean | 1035 |
10.0
| 45 | 20.9 | 11.3 | |||
Wilson 2013 [66] | Ileostomy | Mean | 13,462 | 11.6 | 217 | 18.7 | ||||
Campbell 2013 [31] | Cabx exposure | Mean | 1641 | 7.8 | 5.7 | 9.9 | 1641 | 29.3 | 34.7 | |
Quimbo 2013 [57] | Concomitant Antibiotic Use | Mean | 17,716 | 7.8 | 7.4 | 8.3 | 4429 | 17.9 | 17.0 | 18.9 |
Lagu 2014 [42] | Sepsis | Mean | 4736 | 5.1 | 4.4 | 5.7 | 2368 | 19.2 | ||
Reed 2008 | Septicemia | Mean | 1211 | 5.0 | 92 | 10.7 | 7.6 | |||
Egorova 2015 [35] | Vascular surgery | Median | 450,251 |
6.7
| 4708 | 15.0 | 9.0a | 25.0a | ||
Flagg 2014 [36] | Cardiac surgery | Median | 349,122 |
10.0
| 2580 | 21.0 | ||||
Glance 2011 [38] | Trauma | Median | 149,656 |
10.0
| 768 | 16.0 | ||||
Lemaire 2015 [43] | Cardiac surgery (CABG) | Median | 421,294 |
12.0
| 19.0 | |||||
Lemaire 2015 [43] | Cardiac surgery (VS) | Median | 90,923 |
16.0
| 24.0 | |||||
Reed 2008 | Congestive Heart Failure | Mean | 2542 |
5.0
| 35 | 9.7 | 7.0 | |||
Reed 2008 | OR procedure for infectious /parasitic diseases | Mean | 449 |
2.0
| 32 | 14.7 | 8.6 | |||
Lawrence 2007 [44] | ICU | Median | 76 | 14.9 | 1.0b | 86.0b | ||||
Lawrence 2007 [44] | ICU | Median | 76 | 38.3 | 4.0b | 184.0b | ||||
Ali 2012 [27] | Liver transplant | Mean | 193,714 |
10.1
| 5159 | 17.8 | ||||
Singal 2014 [60] | Cirrhosis | Mean | 89,673 |
7.5
| 1444 | 13.9 | ||||
Quimbo 2013 [57] | Immunocompromised | Mean | 14,344 | 8.4 | 7.9 | 9.0 | 3586 | 22.1 | 20.6 | 23.7 |
Campbell 2013 [31] | Renal impairment | Mean | 3236 | 4.0 | 2.9 | 5.1 | 3236 | 22.7 | 28.2 | |
Quimbo 2013 [57] | Renal impairment | Mean | 22,132 | 17.3 | 16.4 | 18.3 | 5533 | 37.5 | 35.5 | 39.6 |
Campbell 2013 [31] | Cancer/BMT | Mean | 782 | 4.0 | 2.3 | 5.7 | 782 | 21.3 | 18.5 | |
Weighted Mean | 10,120,864 | 7.8 | 168,892 | 13.5 | ||||||
Both CO-CDI and HO-CDI inpatient cost | ||||||||||
Song 2008 [61] | General | Median | 1260 |
4.0
| 630 | 22.0 | ||||
Stewart 2011 [62] | General | Mean | 82,414 |
5.1
| 41,207 | 13.0 | 14.0 | |||
Nylund 2011 [50] | Children, 1997 | Median | 3565 | 3.0 | 3565 | 5.0 | 3.0a | 14.0a | ||
Nylund 2011 [50] | Children, 2000 | Median | 4356 | 4.0 | 4356 | 6.0 | 3.0a | 15.0a | ||
Nylund 2011 [50] | Children, 2003 | Median | 5574 | 4.0 | 5574 | 6.0 | 3.0a | 14.0a | ||
Nylund 2011 [50] | Children, 2006 | Median | 7779 | 4.0 | 7779 | 6.0 | 3.0a | 15.0a | ||
Sammons 2013 [59] | Children | Median | 698,616 | 12.2 | 10.6 | 13.8 | 698,616 | 10.0 | 5.0a | 23.0a |
Bajaj 2010 [30] | Cirrhosis | Mean | 83,230 | 7.1 | 1165 | 14.4 | ||||
Bajaj 2010 [30] | CDI only | Mean | 58,220 | 12.7 | ||||||
Pant 2013 [55] | IBD | Mean | 12,610 | 2.2 | 1.5 | 2.8 | 447 | 8.2 | ||
Dubberke 2008 [33] | Non-surgical | Median | 24,691 |
6.0
| 439 | 10.0 | 2. 0b | 87.0b | ||
Lawrence 2007 [44] | ICU stay | Median | 1872 |
3.1
| 76 | 6.1 | 1.0b | 86.0b | ||
Lawrence 2007 [44] | Hospital stay | Median | 1872 |
14.4
| 76 | 24.5 | 2.0b | 184.0b | ||
Maltenfort 2013 [47] | Arthroplasty | Median | – | 7.0 | – | 10.0 | 7.0a | 17.0a | ||
Zerey 2007 [67] | Surgical | Median | 1,553,597 | 16.0 | 15.6 | 16.4 | 8113 | 18.0 | ||
Pant 2012 [53] | Organ transplant | Median | 49,198 | 9.6 | 9.3 | 9.9 | 63,651 | |||
Pant 2012 (2) [54] | Renal disease | Coefficient | 184,139 | 9.4 | 9.2 | 9.5 | 59,793 | |||
Zilberberg 2009 [68] | Prolonged acute mechanical ventilation | Median | 3370 | 6.1 | 4.9 | 7.4 | 3468 | 25.0 | 15.0a | 40.0a |
Weighted Mean | 2,718,143 | 13.6 | 957,175 | 9.0 |
CDI category | CDI-attributable cost per case (2015 US$) | CDI-related cost per case (2015 US$) | CDI-attributable LOS per case (Days) | CDI-related LOS per case (Days) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Weighted mean | 90 % CI | Weighted mean | 90 %CI | Weighted mean | 90 % CI | Weighted mean | 90 % CI | |||||
CO-CDI | 20,095 | 4991 | 35,204 | 23,329 | 12,520 | 34,141 | 5.7 | 4.1 | 7.3 | 5.7 | 4.1 | 7.3 |
HO-CDI | 34,157 | 33,134 | 35,180 | 53,487 | 42,054 | 66,326 | 9.7 | 9.7 | 9.7 | 14.1 | 13.0 | 15.4 |
Both CO-CDI and HO-CDI | 17,650 | 17,292 | 18,009 | 46,000 | 42,502 | 49,533 | 10.4 | 9.7 | 11.0 | 11.8 | 7.1 | 17.6 |
Overall inpatient | 21,448 | 21,152 | 21,744 | 42,316 | 39,886 | 44,765 | 9.7 | 9.6 | 9.8 | 11.1 | 8.7 | 13.6 |
CDI annual national impact estimate
Total number of HCF CDI cases per year (2011) [25] | Mean | 95 % CI | |
---|---|---|---|
All population ≥2 years Median | 293,300 | 264,200 | 322,500 |
Adults ≥18 Upper boundary | 288,900 | 261,100 | 316,700 |
Adults ≥18 Lower boundary | 133,887 | 91,780 | 195,402 |
Cost per CDI case management (2015 US$) | Weighted Mean | 90 % CI | |
Overall CDI-attributable cost | 21,448 | 21,152 | 21,744 |
Overall CDI-related cost | 42,316 | 39,886 | 44,765 |
Total cost per year (in Billions, 2015 US$) | Weighted Mean | Range | |
Total CDI-attributable cost per year | 6.29 | 1.94 | 7.01 |
Mean | 6.29 | 5.59 | 7.01 |
Upper boundary | 6.19 | 5.52 | 6.88 |
Lower boundary | 2.87 | 1.94 | 4.25 |
Total CDI-related cost per year | 12.41 | 3.66 | 14.44 |
Mean | 12.41 | 5.59 | 14.44 |
Upper boundary | 12.25 | 10.41 | 14.18 |
Lower boundary | 5.67 | 3.66 | 8.75 |