OBJECTIVES:

Yearly, Clostridioides difficile (C. diff) leads to almost half a million infections among patients in the U.S. Inpatient C. diff infections (CDI) are attributed to greater institutional costs and worse patient outcomes, which include increased: (1) total length of stay (LOS); (2) rates of intensive care unit (ICU) admission; and (3) inpatient mortality. Reducing risk factors for C. diff transmission and incorporating effective infection control measures lead to demonstrated improvements in overall outcomes and quality measures. Among these strategies, LOS-focused interventions, whereby the potential C. diff exposure time is reduced, have shown to decrease overall transmission rates and positively impact patient outcomes.

The diagnosis of CDI is based on a combination of both observed clinical symptoms and diagnostic tests that either detect the presence of the toxin antigen via enzyme immunoassays (EIAs) or the organism directly using nucelic acid amplification tests (NAATs).

Here, we assess the impact to inpatient LOS relative to the CDI diagnostic test method used based on discharges captured in the Premier Healthcare Database, a patient-level data warehouse containing de-identified inpatient and outpatient records from over 700 U.S.-based hospitals.

METHODS:

The retrospective observational cohort study included patients with a discharge code of CDI between January 1, 2011 and December 31, 2016. Matched patients tested by either NAAT or EIA were included in the analysis, with a total of 11,180 patients per group.

RESULTS:

The mean LOS for CDIs diagnosed with NAATs and EIAs were 9.51 (95% CI: 9.34-9.68) and 10.27 (95% CI: 10.08-10.46) days, respectively (P < 0.0001).

CONCLUSIONS:

The use of a NAAT assay for the diagnosis of CDI demonstrated an overall, and significant, reduced LOS. Due to the correlation between LOS and CDI transmission rates, any measure aimed at reducing LOS should be considered as part of a larger CDI-prevention strategy.