The Turkish Journal of Pediatrics 2021 , Vol 63 , Num 6
Cost and length of hospital stay for healthcare facilityonset Clostridioides Difficile infection in pediatric wards: a prospective cohort analysis
Sevliya Öcal Demir 1 ,Eda Kepenekli 2 ,Gülşen Akkoç 3 ,Nurhayat Yakut 4 ,Ahmet Soysal 5
1 Division of Pediatric Infectious Diseases, Department of Pediatrics, İstanbul Medeniyet University Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul
2 Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul;
3 Division of Pediatric Infectious Diseases, University of Health Sciences, İstanbul Haseki Training and Research Hospital, İstanbul;
4 Clinic of Pediatric Infectious Diseases, Başakşehir Çam and Sakura City Hospital, İstanbul
5 Clinic of Pediatric Infectious Diseases, Memorial Ataşehir Hospital, İstanbul, Turkey
DOI : 10.24953/turkjped.2021.06.008 Background. Clostridioides difficile (C. difficile) is a well-known causative agent of healthcare associated infection, it increases medical cost besides increasing morbidity and mortality. This study was conducted to determine the incidence, and economic burden of healthcare facility-onset C. difficile infection (HO-CDI) in children.

Methods. Data was acquired with a prospective cohort study conducted in pediatric wards of a tertiary university hospital between August 2015 to August 2016. The HO-CDI was defined as diarrhea that began after 48 hours of admission with a positive cytotoxic stool assay for the presence of toxin A and/or B of C. difficile.

Results. In the 3172 admissions in one year, 212 (7%) healthcare associated diarrhea (HAD) episodes were observed, in 25 (12%) of them C. difficile was identified in which 6 (25%) cases <2-year-old. The incidence of HOCDI was estimated as 8.8/10,000 patient-days. Cases with HO-CDI (n=19) were compared with cases with non- CDI-HAD (n=102); the presence of one of the risk factors for CDI increased the risk for HO-CDI (5,05; 95% Cl: 1.10-23.05; P 0,037), the median length of stay (LOS) attributable HO-CDI was 7 days (IQR,5-10) per admission, whereas for non-CDI-HAD was 2 days (IQR,0-4) (p=0.036). General hospitalization costs in the two groups were similar, specifically estimated costs attributable to HO-CDI and non-CID-HAD were $294.0 and $137.0 per hospitalization respectively (p=<0.0001).

Conclusion. Although in children the incidence of HO-CDI is increasing, its clinical manifestation is still milder and effective infection control measures with antibiotic stewardship can limit related morbidly, mortality, LOS, and cost. Keywords : health-care, HO-CDI, C. difficile, cost, pediatric

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