Hospital-acquired C. difficile lengthens hospital stay, retrospective study shows

Hospital-acquired Clostridium difficile significantly prolongs the duration of a patient's stay in the hospital by at least 6 days, according to the findings of a study published online December 5, for the Canadian Medical Association Journal.

Alan J. Forster, MD, MSc, from the University of Ottawa, and colleagues conducted a retrospective observational cohort study to measure the independent association between infection with hospital-acquired C. difficile and time to discharge, accounting for each patient's risk of death upon admission and the variable time each patient spent in the hospital before acquiring the bacteria.

Looking at a single academic hospital between July 1, 2002, and March 31, 2009, researchers identified 1,393 of 136,877 patients who contracted hospital-acquired infection with C. difficile (overall risk 1.02%; 95% CI, 0.97%–1.06%). Of these, 75.5% were identified on or after the 7th day spent in the hospital.

The crude median length of hospital stay was 34 days for patients with hospital-acquired C. difficile and 8 days for those without. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI, 0.39–0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI, 0.32–0.58) for those in the highest decile; while the hazard ratios for discharge by day 28 were 0.74 (95% CI, 0.60–0.87) and 0.61 (95% CI, 0.53–0.68), demonstrating that C. difficile had a larger impact on length of stay for patients at higher baseline risk.

"We found that the impact of hospital-acquired C. difficile on length of stay is more conservative than previous estimates have suggested," the authors noted. "Nevertheless, the impact remains large, especially when one considers the aggregated impact."