Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-30T23:17:42.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of Clostridium difficile–Associated Disease Surveillance Definitions, North Carolina, 2005

Published online by Cambridge University Press:  02 January 2015

Preeta K. Kutty ,
Stephen R. Benoit ,
Christopher W. Woods ,
Arlene C. Sena ,
Susanna Naggie ,
Joyce Frederick ,
John Engemann ,
Sharon Evans ,
Brian C. Pien  and
Shailendra N. Banerjee
...Show all authors
Preeta K. Kutty
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Stephen R. Benoit
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Christopher W. Woods
Affiliation:
Department of Veterans Affairs Medical Center, Durham Duke University Medical Center, Division of Infectious Diseases, Durham
Arlene C. Sena
Affiliation:
Durham County Health Department, Durham Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Susanna Naggie
Affiliation:
Department of Veterans Affairs Medical Center, Durham Duke University Medical Center, Division of Infectious Diseases, Durham
Joyce Frederick
Affiliation:
Department of Veterans Affairs Medical Center, Durham
John Engemann
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Sharon Evans
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Brian C. Pien
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Shailendra N. Banerjee
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Jeffery Engel
Affiliation:
North Carolina Department of Health and Human Services, Raleigh, North Carolina
L. Clifford McDonald*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, MS A-31, 1600 Clifton Rd NE, Atlanta, GA 30333 ([email protected].)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the timing of community-onset Clostridium difficile–associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility–onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.

Design.

Retrospective cohort study for the period January 1, 2005, through December 31, 2005.

Setting.

Catchment areas of 6 acute care hospitals in North Carolina.

Methods.

We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin–assay results. Cases were classified as healthcare facility–onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility–associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility–onset, healthcare facility–associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases.

Results.

Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P<.001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included.

Conclusions.

A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility–associated CDAD that includes cases that occur within 4 weeks after discharge.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 3 , March 2008 , pp. 197 - 202
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Pépin, J, Valiquette, L, Alary, M, et al.Clostridium difficile–associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.Google Scholar
2.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2001. Emerg Infect Dis 2006;12:409–415.Google Scholar
3.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346–353.Google Scholar
4.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar
5.Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.Google Scholar
6.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
7.Hirschhorn, LR, Trnka, Y, Onderdonk, A, Lee, MT, Platt, R. Epidemiology of community-acquired Clostridium difficle–associated diarrhea. J Infect Dis 1994;169:127–133.Google Scholar
8.Norén, T, Akerlund, T, Back, E, et al.Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol 2004;42:3635–3643.CrossRefGoogle Scholar
9.Dial, S, Delaney, JA, Barkun, AN, Suissa, S. Use of gastric acid–suppressive agents and the risk of community-acquired Clostridium difficile–associated disease. JAMA 2005;294:2989–2995.CrossRefGoogle ScholarPubMed
10.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. (published correction appears in Am J Infect Control 1988;16:177). Am J Infect Control 1988;16:128–140.Google Scholar
11.Sohn, S, Climo, M, Diekema, D, et al.Varying rates of Clostridium difficile–associated diarrhea at Prevention Epicenter Hospitals. Infect Control Hosp Epidemiol 2005;26:676–679.CrossRefGoogle ScholarPubMed
12.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK, and the Ad Hoc Clostridium difficile Surveillance Working Group. Recommendations for Surveillance of Clostridium difficile–Associated Disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
13.Kutty, PK, Benoit, S, Woods, C, et al.Emerging Clostridium difficile–associated disease in the community and the role of non-antimicrobial risk factors. In: Program and abstracts of the 44th Annual Meeting of Infectious Disease Society of America; October 12-15, 2006; Toronto, Ontario. Abstract LB-28.Google Scholar
14.Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonization and disease. Lancet 1990;336:97–100.Google Scholar
15.Palmore, TN, Sohn, S, Malak, SF, Eagan, J, Sepkowitz, KA. Risk factors for acquisition of Clostridium difficile–associated diarrhea among outpatients at a cancer hospital. Infect Control Hosp Epidemiol 2005;26:680–684.CrossRefGoogle Scholar
16.Chang, H, Parada, J, Evans, C, Johnson, S, Gerding, DN. Onset of symptoms and time to diagnosis of Clostridium difficile–associated disease following discharge from an acute care hospital. Infect Control Hosp Epidemiol 2007;28:926–931.Google Scholar
17.Mayfield, J, McMullen, K, Dubberke, E. Comparison of Clostridium difficile–associated disease rates using a traditional vs. expanded definition. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; March 18-21, 2006; Chicago, IL. Abstract 180.Google Scholar
18.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
19.Kyne, L, Warny, M, Qamar, A, Kelly, CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000;342:390–397.Google Scholar
20.Kyne, L, Warny, M, Qamar, A, Kelly, CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001;357:189–193.Google Scholar
21.Shim, JK, Johnson, S, Samore, MH, Bliss, DZ, Gerding, DN. Primary symptomless colonization by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet 1998;351:633–636.Google Scholar