HEALTH-CARE RESOURCE UTILIZATION AND ANTIMICROBIAL USE IN ELDERLY PATIENTS WITH COMMUNITY-ACQUIRED LOWER RESPIRATORY-TRACT INFECTION WHO DEVELOP CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA
Ap. Macgowan et al., HEALTH-CARE RESOURCE UTILIZATION AND ANTIMICROBIAL USE IN ELDERLY PATIENTS WITH COMMUNITY-ACQUIRED LOWER RESPIRATORY-TRACT INFECTION WHO DEVELOP CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA, Journal of antimicrobial chemotherapy, 39(4), 1997, pp. 537-541
We conducted a prospective observational study on the medical manageme
nt and health service resource utilization associated with the hospita
l care of patients with community-acquired lower respiratory tract inf
ection. Between January 1994 and June 1995, 28 such patients developed
Clostridium difficile-associated diarrhoea; these 28 patients were ma
tched with 56 age-matched patients, who were used as a control group i
n a comparative study. Progress during the first week after admission
was similar as measured by fever days and pathology or radiology use.
The use of iv cephalosporins (g/day) during the first week was greater
in the group who developed C. difficile-associated diarrhoea than in
controls. The length of hospital stay was 36.4 +/- 21.6 days in patien
ts with C. difficile-associated diarrhoea compared with 19.8 +/- 13.3
days in controls. Cases also required more pathological and radiologic
al tests and greater use of antimicrobials and other drugs; however, i
f pathology and radiology use was calculated per day of patient stay t
here was no difference between the two groups. When antimicrobial use
was compared, controlling for the time taken until found to be C. diff
icile toxin positive, patients with C. difficile infection received mo
re iv cefuroxime as well as more total cephalosporins, beta-lactams an
d macrolides measured in g/day. Interestingly, in this study we could
not show an increased mortality associated with C. difficile diarrhoea
despite obvious evidence of morbidity. The development of C. difficil
e-associated diarrhoea substantially increases health care resource ut
ilization for individual patients who are admitted to hospital with lo
wer respiratory tract infection.