HEALTH-CARE RESOURCE UTILIZATION AND ANTIMICROBIAL USE IN ELDERLY PATIENTS WITH COMMUNITY-ACQUIRED LOWER RESPIRATORY-TRACT INFECTION WHO DEVELOP CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA

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.