Excess burden associated with Clostridioides difficile infection in haematological patients occurring during hospitalization with induction chemotherapy in the USA

Summary BACKGROUND Patients with haematological diseases are at high risk of developing Clostridioides difficile infection (CDI). AIM The study aim was to describe excess length of stay and costs associated with CDI during the hospital stay for induction chemotherapy in the United States (US). METHODS A retrospective analysis was conducted utilizing data from US databases of Truven Health Analytics®. Comprehensive hospitalization data of patients with induction chemotherapy due to acute myeloid leukaemia (AML), acute lymphoblastic leukaemia, Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) were analyzed. Patients with CDI occurring during the hospital stay were compared to controls through a case-control comparison of the direct treatment costs and length of stay was performed with an exact matching algorithm. FINDINGS 2,611 patients were included between 01/2014 and 12/2017. NHL (43.5%) and AML (38.4%) were the predominant underlying diseases and 15% of patients received a stem cell transplantation. During the matching, 105 CDI cases (CDI+) were compared with 801 controls (CDI-). On average, hospitalization costs were increased by US$36,113 in CDI+ compared to CDI- patients (p=0.009) and patients with CDI spent on average 8.9 additional days in hospital (p=0.003). CONCLUSION The findings highlight a significant burden associated with CDI in haematological patients undergoing induction chemotherapy in the US. There is an important need for prevention of CDI in this specific patient population.