Outcomes and expenditures of clostridium difficile infection in pediatric solid organ transplant recipients
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The main purpose of this study was to assess outcomes (i.e., inpatient mortality, transplant failure or rejection, colectomy, and hospital length of stay) of clostridium difficile infection (CDI) and the association of expenditures (i.e., charges and costs) and CDI in pediatric solid organ transplant (SOT) recipients. Data from the 2000, 2003, 2006, and 2009 Kids’ Inpatient Database (KID) files were used to identify events with SOT- related ICD-9-CM diagnosis codes. Logistic regression was used to assess the association of CDI and dichotomous outcome variables, while log-linked gamma regression models were used to assess the association of CDI and continuous outcome variables. Methods accounting for the complex survey sample design of the KID were used when performing all statistical analyses. The total number of pediatric SOT hospital events was 48,286. The overall prevalence of CDI for pediatric SOT hospitalizations was 1.76%. For SOT hospitalizations with CDI, inpatient mortality was 1.63%; the prevalence of transplant failure or rejection events was 27.71%; the prevalence of a colectomy was 4.86%. The median hospital length of stay was seven days; the median charge and cost for each hospitalization was $48,409 and $17,412, respectively. The results showed that CDI was not significantly associated with inpatient mortality or transplant failure/ rejection in pediatric SOT hospitalizations. SOT patients with CDI were 2.6 times more likely to have a colectomy than SOT patient without CDI. The mean hospital length of stay (LOS) for a SOT admission with CDI was approximately 2 times the mean LOS for a SOT admission without CDI. The mean charges and the mean costs for a SOT admission with CDI was approximately 2 times that for a SOT admission without CDI. In conclusion, CDI diagnoses were not significantly associated with higher inpatient mortality or transplant failure/ rejection for pediatric SOT hospitalizations. But CDI was significantly associated with a higher prevalence of a colectomy, longer hospital LOS, higher charges, and higher costs (all p<0.05). To avoid substantially higher expenditures and health care utilization, CDI in pediatric SOT recipients should be prevented when possible and promptly diagnosed and treated when it occurs.