In our study, which considered the impact of the testing assay on duration of inpatient stay, Xpert C. difficile real-time PCR was found to produce cost savings in almost all scenarios investigated in comparison to CCNA. Although differences in LOS were not statistically significant in this study, a clear trend is visible towards

potentially large NF-��B inhibitor cost savings when PCR-based methods are used for C. difficile detection in comparison to CCNA. This trend should be further confirmed by future studies adequately powered to overcome the large variance in LOS data. The mean LOS for patients with suspicion of CDI between 38 and 48 days found in this study is higher compared to LOS reported in other studies. Forster et al. [8] reported a HCS assay median LOS of 34 days, Vonberg et al. [7] found a median LOS of 27 days, Song et al. [10] 22 days, and Campbell et al. [9] stated a mean duration between 21.0 and 29.3 days for patients suffering from CDI acquired in hospital. However, click here with the exception

of Campbell et al. [9], the mean age of patient populations was considerably younger with 63.2 years [8], 55.9 years [7], and 57.6 years [10], compared to 75 years in our study, which may explain the longer LOS due to potentially higher incidence of co-morbidities. The cost comparison discussed here only considers the cost of diagnostic tests and the change in duration of hospital stay observed in this study. This approach appears valid considering that cost of additional bed days has been identified as the main cost driver in CDI comprising up to 94% of the overall costs [21, 22]. However, it may underestimate potential additional cost savings due to cost reductions in antibiotic treatment and isolation days,

as found by other studies [23, 24]. Rapid PCR testing has also been suggested to have the potential for cost savings for detection of methicillin-resistant Staphylococcus aureus [25] and sepsis [26] and to result in cost savings of $1,037 per patient in infants with fever and cerebrospinal fluid pleocytosis [27]. To our knowledge, this study is the first to publish an investigation of potential cost savings with a PCR assay for diagnosing CDI compared GNA12 to CCNA. The potential cost savings identified in our study may be attributed to the faster turnaround time of PCR-based screening tests allowing for more efficient and accurate patient management, which eventually results in decreased average LOS of 4.88 days for CDI positive and 7.03 for negative patients. Forster et al. [8] suggested that calculating LOS differences based on the overall LOS, not treating C. difficile as a time-varying co-variable, overestimates the effect of CDI on duration of hospital stay as LOS before CDI will be incorrectly attributed to C. difficile.