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Hospital-Associated Clostridium difficile Infection: Is It Necessary to Track Community-Onset Disease?

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke*
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Kathleen M. McMullen
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Jennie L. Mayfield
Affiliation:
Barnes-Jewish Hospital, St. Louis, Missouri
Kimberly A. Reske
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Peter Georgantopoulos
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
David K. Warren
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
*
660 South Euclid Avenue, Box 8051, St. Louis, MO 63110 ([email protected])

Abstract

Objectives.

To compare Clostridium difficile infection (CDI) rates determined with use of a traditional definition (ie, with healthcare-onset CDI defined as diagnosis of CDI more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset CDI and community-onset CDI, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients with CDI onset in the community and those with CDI onset in a healthcare setting.

Design.

Prospective cohort

Setting.

Tertiary acute care facility.

Patients.

General medicine patients who received a diagnosis of CDI during the period January 1, 2004, through December 31, 2005.

Methods.

CDI was classified as healthcare-onset CDI, healthcare facility–associated CDI after hospitalization within the previous 30 days, and/or healthcare facility-associated CDI after hospitalization within the previous 60 days. Patient demographic characteristics and medication exposures were obtained. The CDI incidence with use of each definition, CDI rate variability, patient demographic characteristics, and medication exposures were compared.

Results.

The healthcare-onset CDI rate (1.6 cases per 1,000 patient-days) was significantly lower than the 30-day healthcare facility–associated CDI rate (2.4 cases per 1,000 patient-days; P<.01) and the 60-day healthcare facility–associated CDI rate (2.6 cases per 1,000 patient-days; P<.01). There was good correlation between the healthcare-onset CDI rate and both the 30-day (correlation, 0.69; P<.01) and 60-day (correlation, 0.70; P<.01) healthcare facility–associated CDI rates. There were no months in which the CDI rate was more than 3 standard deviations from the mean. Compared with patients with healthcare-onset CDI, patients with community-onset CDI were less likely to have received a fourth-generation cephalosporin (P = .02) or intravenous vancomycin (P = .01) during hospitalization.

Conclusions.

Compared with the traditional definition, expanded definitions identify more patients with CDI. There is good correlation between traditional and expanded CDI definitions; therefore, it is unclear whether expanded surveillance is necessary to identify an abnormal change in CDI rates. Cases that met the expanded definitions were less likely to have occurred in patients with fourth-generation cephalosporin and vancomycin exposure.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.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;28:140145.CrossRefGoogle ScholarPubMed
2.Kutty, PK, Benoit, SR, Woods, CW, et al.Assessment of Clostridium difficile–associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008;29:197202.CrossRefGoogle ScholarPubMed
3.Paltansing, S, van den Berg, RJ, Guseinova, RA, Visser, CE, van der Vorm, ER, Kuijper, EJ. Characteristics and incidence of Clostridium difficile–associated disease in The Netherlands, 2005. Clin Microbiol Infect 2007;13:10581064.Google Scholar
4.Price, MF, Dao-Tran, T, Garey, KW, et al.Epidemiology and incidence of Clostridium difficile–associated diarrhoea diagnosed upon admission to a university hospital. J Hosp Infect 2007;65:4246.CrossRefGoogle ScholarPubMed
5.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.Google Scholar
6.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613619.CrossRefGoogle ScholarPubMed
7. The Association for Professionals in Infection Control and Epidemiology, Inc. National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities. Available at: http://www.apic.org/AM/CM/ContentDisplay.cfm?ContentFileID=11410. Accessed November 17, 2008.Google Scholar
8.Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonald, LC, Fraser, VJ. Clostridium difficile–associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45:15431549.Google Scholar
9.Dubberke, ER, Reske, KA, Olsen, MA, et al.Evaluation of Clostridium difficile–associated disease pressure as a risk factor for C difficile–associated disease. Arch Intern Med 2007;167:10921097.Google Scholar
10.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;166:561567.CrossRefGoogle ScholarPubMed
11.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204210.Google Scholar
12.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile–associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.Google Scholar
13.Simor, AE, Bradley, SF, Strausbaugh, LJ, Crossley, K, Nicolle, LE. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696703.Google Scholar
14.Wong, ES, Rupp, ME, Mermel, L, et al.Public disclosure of healthcare-associated infections: the role of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2005;26:210212.Google Scholar