Wingen-Heimann Sebastian M, Davies Kerrie, Viprey Virginie F, Davis Georgina, Wilcox Mark H, Vehreschild Maria J G T, Lurienne Lise, Bandinelli Pierre-Alain, Cornely Oliver A, Vilken Tuba, Hopff Sina M, Vehreschild Jörg Janne
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; University of Applied Sciences for Economics and Management (FOM), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf, Cologne, Germany.
Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom; The European Study Group for C. difficile, European Society of Clinical Microbiology and Infectious Disease.
Clin Microbiol Infect. 2023 May;29(5):651.e1-651.e8. doi: 10.1016/j.cmi.2022.12.019. Epub 2022 Dec 29.
Clostridioides difficile infection (CDI) is one of the leading nosocomial infections worldwide, resulting in a significantly increasing burden on the healthcare systems. However, Pan-European data about cost and resource utilization of CDI treatment do not exist.
A retrospective analysis within the Combatting Bacterial Resistance in Europe CDI project was conducted based on resource costs for inpatient treatment and productivity costs. Country-specific cost values were converted to EURO referred to 1 January, 2019 values. Differences in price levels for healthcare services among the participating countries were adjusted by using an international approach of the Organisation for Economic Co-operation and Development. As the study focused on patients with recurrent CDI, the observed study population was categorized into (a) patients with CDI but without CDI recurrence (case group), (b) patients with CDI recurrence (recurrence group), and (c) patients without CDI (control group).
Overall, 430 hospitalized patients from 12 European countries were included into the analysis between July 2018 and November 2018. Distribution of mean hospital length of stay and mean overall costs per patient between the case group, recurrence group, and control group were as follows: 22 days (95% CI 17-27 days) vs. 55 days (95% CI 17-94 days) vs. 26 days (95% CI 22-31 days; p 0.008) and € 15 242 (95% CI 10 593-19 891) vs. € 52 024 (95% CI 715-103 334) vs. € 21 759 (95% CI 16 484-27 035; p 0.010), respectively. The CDI recurrence rate during the observational period was 18%. Change escalation in CDI medication (OR 3.735) and treatment in an intensive care unit (OR 5.454) were found to be the most important variables associated with increased overall costs of patients with CDI.
Treatment of patients with recurrent CDI results in a significant burden. Prevention of CDI recurrences should be in focus of daily patient care to identify the most cost-effective treatment strategy.
艰难梭菌感染（CDI）是全球主要的医院感染之一，给医疗系统带来了日益沉重的负担。然而，目前尚无关于CDI治疗成本和资源利用的泛欧洲数据。
在欧洲抗击细菌耐药性CDI项目中，基于住院治疗的资源成本和生产力成本进行了回顾性分析。将各国特定的成本值转换为以2019年1月1日为基准的欧元值。使用经济合作与发展组织的国际方法对参与国之间医疗服务价格水平的差异进行了调整。由于该研究聚焦于复发性CDI患者，观察到的研究人群被分为（a）患有CDI但无CDI复发的患者（病例组），（b）患有CDI复发的患者（复发组），以及（c）无CDI的患者（对照组）。
总体而言，2018年7月至2018年11月期间，来自12个欧洲国家的430名住院患者被纳入分析。病例组、复发组和对照组之间的平均住院天数和每位患者的平均总成本分布如下：22天（95%置信区间17 - 27天）对55天（95%置信区间17 - 94天）对26天（95%置信区间22 - 31天；p = 0.008），以及15242欧元（95%置信区间10593 - 19891欧元）对52024欧元（95%置信区间715 - 103334欧元）对21759欧元（95%置信区间16484 - 27035欧元；p = 0.010）。观察期内CDI复发率为18%。发现CDI药物治疗的变化升级（比值比3.735）和在重症监护病房的治疗（比值比5.454）是与CDI患者总体成本增加相关的最重要变量。
复发性CDI患者的治疗会带来重大负担。预防CDI复发应成为日常患者护理的重点，以确定最具成本效益的治疗策略。
