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Multicenter Study of Clostridium difficile Infection Rates from 2000 to 2006

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke ,
Anne M. Butler ,
Deborah S. Yokoe ,
Jeanmarie Mayer ,
Bala Hota ,
Julie E. Mangino ,
Yosef M. Khan ,
Kyle J. Popovich ,
Victoria J. Fraser  and
Prevention Epicenters Program from the Centers for Disease Control and Prevention
Erik R. Dubberke*
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Anne M. Butler
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
Deborah S. Yokoe
Affiliation:
Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
Jeanmarie Mayer
Affiliation:
Department of Medicine, University of Utah Hospital, Salt Lake City, Utah
Bala Hota
Affiliation:
Department of Medicine, John H. Stroger Jr. Hospital of Cook County andRush University Medical Center, Chicago, Illinois
Julie E. Mangino
Affiliation:
Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
Yosef M. Khan
Affiliation:
Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
Victoria J. Fraser
Affiliation:
Department of Medicine, Washington University School of Medicine, St Louis, Missouri
*
Department of Medicine, Washington University School of Medicine, Box 8051, 660 South Euclid, St Louis, MO 63110, ([email protected])
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Extract

Objective.

To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.

Methods.

Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the χ2 test for trend and the χ2 summary test.

Results.

During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.

Conclusions.

The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 10 , October 2010 , pp. 1030 - 1037
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Dallai, RM, Harbrecht, BG, Boujoukas, AJ, et al.Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235(3):363–372.Google Scholar
2.Gravel, D, Miller, M, Simor, A, et al; Canadian Nosocomial Infection Surveillance Program. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009;48(5):568–576.CrossRefGoogle Scholar
3.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality [published correction appears in N Engl J Med 2006;354(20):2200]. N Engl J Med 2005;353(23):2442–2449.CrossRefGoogle Scholar
4.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353(23):2433–2441.Google Scholar
5.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerglnfect Dis 2006;12(3):409–415.Google Scholar
6.Sohn, S, Climo, M, Diekema, D, et al; Prevention Epicenter Hospitals. Varying rates of Clostridium difficile-associated diarrhea at prevention epicenter hospitals. Infect Control Hosp Epidemiol 2005;26(8):676–679.CrossRefGoogle ScholarPubMed
7.Campbell, RJ, Giljahn, L, Machesky, K, et al.Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30(6):526–533.CrossRefGoogle ScholarPubMed
8.Kutty, PK, Benoit, SR, Woods, CW, et al.Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008;29(3):197–202.Google Scholar
9.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28(2):140–145.Google Scholar
10.Zilberberg, MD, Shorr, AF, Kollef, MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis 2008;14(6):929–931.CrossRefGoogle ScholarPubMed
11.Belmares, J, Johnson, S, Parada, JP, et al.Molecular epidemiology of Clostridium difficile over the course of 10 years in a tertiary care hospital. Clin Infect Dis 2009;49(8):1141–1147.CrossRefGoogle ScholarPubMed
12.Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166(3):561–567.Google Scholar
13.Dubberke, ER. The A, B, BI, and Cs of Clostridium diffidle. Clin Infect Dis 2009;49(8):1148–1152.Google Scholar
14.Samore, MH, Bettin, KM, DeGirolami, PC, Clabots, CR, Gerding, DN, Karchmer, AW. Wide diversity of Clostridium diffidle types at a tertiary referral hospital. J Infect Dis 1994;170(3):615–621.Google Scholar
15.Dubberke, ER, Butler, AM, Hota, B, et al.Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. diffidle infection. Infect Control Hosp Epidemiol 2009;30(6):518–525.CrossRefGoogle ScholarPubMed