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Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke ,
Anne M. Butler ,
Bala Hota ,
Yosef M. Khan ,
Julie E. Mangino ,
Jeanmarie Mayer ,
Kyle J. Popovich ,
Kurt B. Stevenson ,
Deborah S. Yokoe  and
L. Clifford McDonald
...Show all authors
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
Bala Hota
Affiliation:
Department of Medicine, John H. Stroger Jr. Hospital, Rush University Medical Center, Chicago, Illinois
Yosef M. Khan
Affiliation:
Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
Julie E. Mangino
Affiliation:
Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
Jeanmarie Mayer
Affiliation:
Department of Medicine, the University of Utah Hospital, Salt Lake City, Utah
Kyle J. Popovich
Affiliation:
Department of Medicine, John H. Stroger Jr. Hospital, Rush University Medical Center, Chicago, Illinois
Kurt B. Stevenson
Affiliation:
Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
Deborah S. Yokoe
Affiliation:
Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, the Centers for Disease Control and Prevention, Atlanta, Georgia
John Jernigan
Affiliation:
Division of Healthcare Quality Promotion, the Centers for Disease Control and Prevention, Atlanta, Georgia
Victoria J. Fraser
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, Box 8051, 660 South Euclid, St. Louis, MO 63110 ([email protected])
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Abstract

Objective.

To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI.

Design.

A retrospective multicenter cohort study.

Setting.

Five university-affiliated, acute care HCFs in the United States.

Methods.

We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July I, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks.

Results.

The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P < .01 ). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (ρ range, 0.94-0.99; P < .001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (k = 0.794; P < .001).

Conclusions.

Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 6 , June 2009 , pp. 518 - 525
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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