Length of Hospital Stay and Charges Attributable to Clostridioides Difficile Infections in Arizona, 2018

Background Clostridioides difficile infection (CDI) is the leading cause of infectious diarrhea and the most common healthcare-associated infection in hospitalized patients. Clostridioides difficile is recognized as an urgent threat given its clinical and economic impact on public health. Patients with CDI face increased healthcare charges not only as a result of the charges associated with diagnosis and treatment, but also due to charges associated with extended hospitalizations and readmissions that can occur. The Arizona Department of Health Services analyzed non-federal hospital discharge data to estimate the associated charges for CDI-related hospitalizations in Arizona. Methods All hospital discharges for year 2018 containing the International Classification of Diseases, Tenth Revision code for intestinal infection due to Clostridioides difficile were extracted from the Arizona Hospital Discharge Database (AHDD). The number of days hospitalized, the total hospital charges, hospital and emergency room utilization, and mortality rates for each CDI case were analyzed. Discharges were stratified by diagnosis level such as principal diagnosis vs. other diagnosis. Results The number of CDI-related hospital discharges in 2018 was 8,629. Among those, 15% (1288) were categorized as recurrent CDI. Among all CDI discharges, 4% (389) of patients died during their hospital visit. Among non-recurrent discharges, 29% were attributed to CDI as the principal diagnosis. Among recurrent discharges, 47% were attributed to CDI as the principal diagnosis. Among those with a principal diagnosis of CDI, recurrent CDI cases showed higher mean hospital charges and number of hospitalized days ($47,608 and 5 days) compared to non-recurrent cases ($36,263 and 4 days). Conclusions CDI continues to have a significant clinical impact among hospitalized patients in Arizona. CDI results in considerable healthcare charges especially among those who experience recurrent CDI. The impact of antibiotic stewardship programs in Arizona should be further explored in light of numerous studies demonstrating cost savings without compromising patient outcomes.