Predictors and burden of hospital readmission with recurrent Clostridioides difficile infection: a French nation-wide inception cohort study

  • Aurélien Dinh
  • Alban Le Monnier
  • Corinne Emery
  • Sarah Alami
  • Élodie Torreton
  • Anne Duburcq
  • François BarbierEmail author
Original Article


To investigate the predictors and burden of hospital readmission with recurrent Clostridioides difficile infection (rCDI) in a large European healthcare system with a low prevalence of hyper-virulent C. difficile clones. We conducted an inception cohort study based on an exhaustive health insurance database and including all survivors of a first hospital stay with CDI over a one-year period (2015) in France. Readmissions with rCDI were defined as a novel hospital stay with CDI within 12 weeks following discharge of the index hospitalization. Risk factors for readmission with rCDI were investigated through multivariate logistic regression analyses. Among the 14,739 survivors of the index hospital stay (females, 57.3%; median age, 74 [58–84] years), 2135 (14.5%) required at least one readmission with rCDI. Independent predictors of readmission were age ≥ 65 years (adjusted odds ratio (aOR), 1.34, 95% confidence interval (CI), 1.21–1.49, P < 0.0001), immunosuppression (aOR, 1.27, 95% CI, 1.15–1.41, P < 0.0001), chronic renal failure (aOR, 1.29, 95% CI, 1.14–1.46, P < 0.0001), and a previous history of CDI (aOR, 2.05, 95% CI, 1.55–2.71, P < 0.0001). The cumulative number of risk factors was independently associated with the hazard of readmission. Mean acute care costs attributable to rCDI were 5619 ± 3594 Euros for readmissions with rCDI as primary diagnosis (mean length of stay, 11.3 ± 10.2 days) and 4851 ± 445 Euros for those with rCDI as secondary diagnosis (mean length of stay, 16.8 ± 18.2 days), for an estimated annual nation-wide cost of 14,946,632 Euros. Hospital readmissions with rCDI are common after an index episode and drive major healthcare expenditures with substantial bed occupancy, strengthening the need for efficient secondary prevention strategies in high-risk patients.


Clostridium difficile Hospital-acquired diarrhea Pseudomembranous colitis Healthcare costs Prevention Risk factors 


Author contribution

Concept and design: A. Dinh, S. Alimi., A. Duburcq and F. Barbier.

Acquisition of data: C. Emery, E. Torreton and A. Duburcq.

Statistical analysis: C. Emery, E. Torreton and A. Duburcq.

Interpretation of results: A. Dinh, A. Le Monnier, A. Duburcq and F. Barbier.

Writing of the manuscript: A. Dinh, A. Le Monnier and F. Barbier.

Critical revision of the manuscript for important intellectual content: all authors.


This study was supported by MSD.

Compliance with ethical standards

The database exploited for this study is registered at the Commission Nationale de l’Informatique et des Libertés (registration number, 2019044), in compliance with French law on electronic data sources. The protocol of this retrospective observational study was not submitted to an ethical committee since all data were fully anonymized at baseline.

Conflict of interest

FB: MSD (conference and lecture fees, conference invitation), Pfizer (conference invitation), BioMérieux (conference fees).

AD: MSD (conference and lecture fees, conference invitation), Pfizer (conference invitation), InfectoPharm (conference and lecture fees), Sanofi-Pasteur (conference and lecture fees), Correvio (conference and lecture fees).

ALM: MSD (conference invitation), Astellas (conference and lecture fees, conference invitation), Pfizer (conference invitation), Cepheid (conference and lecture fees), bioMérieux (conference and lecture fees), Sanofi-Pasteur (conference and lecture fees).

Other authors: no conflict of interest to declare.

Supplementary material

10096_2019_3552_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 30 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Aurélien Dinh
    • 1
    • 2
  • Alban Le Monnier
    • 3
    • 4
  • Corinne Emery
    • 5
  • Sarah Alami
    • 6
  • Élodie Torreton
    • 5
  • Anne Duburcq
    • 5
  • François Barbier
    • 7
    Email author
  1. 1.Infectious Diseases Unit, APHPRaymond-Poincaré University HospitalGarchesFrance
  2. 2.Versailles-Saint Quentin UniversityVersaillesFrance
  3. 3.Department of Clinical MicrobiologyGH Paris Saint-Joseph HospitalParisFrance
  4. 4.EA4043-UBaPSSaclay - Paris Sud UniversityChâtenay-MalabryFrance
  5. 5.CEMKA-EVALBourg-la-ReineFrance
  6. 6.MSDCourbevoieFrance
  7. 7.Medical Intensive Care UnitLa Source Hospital, CHR OrléansOrléansFrance

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