C.diff recurrence ‘takes thousands of hospital beds’

Repeated infection with the Clostridium difficile (C. Diff.) bacterium is linked to higher death rates and costs health services millions of pounds and thousands of hospital bed days, according to research involving the University of Strathclyde. 

The study found that, in Scotland alone, the additional impact from C.Diff infections amounted to 10,600 bed days a year- the equivalent to a 30-bed hospital ward being fully occupied all year.

The year to October 2016 saw 1150 cases of C.diff infection in Scotland, in patients aged 15 and over. This had a total cost to the NHS in Scotland of £8.65 million, of which approximately £1.95 million pounds was additional costs owing to C.diff. The average cost for a patient with C. diff was £7,500, compared with £2,800 for patients with other medical conditions.

Strathclyde carried out analysis of data for the study, which also involved the Universities of Glasgow, and Dundee and Leeds. The findings are to be presented at the European Congress of Clinical Microbiology and Infectious Diseases in Vienna.

Strathclyde’s team was led by Professor Chris Robertson, of the University’s Department of Mathematics and Statistics. He said:  “C. difficile is an infection that people can acquire in the community as well as in hospital. There has been a great deal of work done in recent years to reduce the number of cases in healthcare settings but this has levelled off lately.

“The people who are most at risk of C. difficile tend to be those who are older, are relatively frail and have a number of chronic conditions.  High levels of exposure to antibiotics is also a strong risk factor for acquiring the infection.”  

 Until now, little has been known about the impact on health service resources from C. diff infections, and on patients in terms of recurrence of infection, readmission to hospital, length of stay and death rates.

The study identified 3304 patients with C. diff in Scottish hospitals between 2010 and 2013 and matched them with a control group of 9516 patients who did not have the infection. Approximately two-thirds of the C. diff patients acquired the infection in hospital.

Risk more than double

The researchers found that patients with C. diff infection had more than double the risk of dying from any cause within two months of being admitted to hospital; nearly a third of all C.diff cases - 29% - died within two months, compared with 14% of patients in the control group.

Patients with C. diff stayed in hospital an average of 9.7 days longer than patients without the infection. Of the 1712 C. diff patients who were discharged from hospital within 30 days of the first episode of infection, 59% were readmitted within six months; of the 626 cases discharged more than 30 days after the first episode, 53% were readmitted within six months.

Few of these readmissions were directly related to C. diff infection. However, 14% who were cured of the initial infection had a recurrence within three months and 29% had a second recurrence within a year.

Older people were more vulnerable to a recurrence. Among the patients with C. diff, 22% were aged 85 or over, and patients aged 75 and over had approximately double the risk of a recurrence of the infection compared with those aged under 65. Patients aged between 65 and 74 had 1.5 times the risk of recurrence compared to younger patients.

The Strathclyde team in the research also included Dr Jiafeng Pan and Dr Kimberley Kavanagh, both of the Department of Mathematics and Statistics, and Professor Marion Bennie, of the Strathclyde Institute of Pharmacy and Biomedical Sciences.  

The study was carried out through the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI), in which Strathclyde is a partner. It was funded by pharmaceutical company Astellas Pharma EMEA.