The prolongation of length of stay because of Clostridium difficile infection

Mitchell, Brett G., Gardner, Anne, Barnett, Adrian G., Hiller, Janet E., & Graves, Nicholas (2014) The prolongation of length of stay because of Clostridium difficile infection. American Journal of Infection Control, 42(2), pp. 164-167.

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Clostridium difficile infection (CDI) possibly extends hospital length of stay (LOS); however, the current evidence does not account for the time-dependent bias, ie, when infection is incorrectly analyzed as a baseline covariate. The aim of this study was to determine whether CDI increases LOS after managing this bias.


We examined the estimated extra LOS because of CDI using a multistate model. Data from all persons hospitalized >48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with health care-associated CDIs were identified. Cox proportional hazards models were applied together with multistate modeling.


One hundred fifty-eight of 58,942 admissions examined had CDI. The mean extra LOS because of infection was 0.9 days (95% confidence interval: −1.8 to 3.6 days, P = .51) when a multistate model was applied. The hazard of discharge was lower in persons who had CDI (adjusted hazard ratio, 0.42; P < .001) when a Cox proportional hazard model was applied.


This study is the first to use multistate models to determine the extra LOS because of CDI. Results suggest CDI does not significantly contribute to hospital LOS, contradicting findings published elsewhere. Conversely, when methods prone to result in time-dependent bias were applied to the data, the hazard of discharge significantly increased. These findings contribute to discussion on methods used to evaluate LOS and health care-associated infections.

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ID Code: 79723
Item Type: Journal Article
Refereed: Yes
Keywords: hospital acquired infection, Clostridium difficile, length of stay, Time-dependent bias, Multistate model, Infection control
DOI: 10.1016/j.ajic.2013.07.006
ISSN: 01966553
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Copyright Statement: NOTICE: this is the author’s version of a work that was accepted for publication in American Journal of Infection Control. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in American Journal of Infection Control Volume 42, Issue 2, February 2014, doi: 10.1016/j.ajic.2013.07.006
Deposited On: 06 Jan 2015 06:31
Last Modified: 07 Feb 2015 05:39

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