title: Survey of incidence of Clostridium difficile infection in Canadian hospitals and diagnostic approaches.
abstract: A questionnaire relating to Clostridium difficile disease incidence and diagnostic practices was sent to 380 Canadian hospitals (all with > 50 beds). The national questionnaire response rate was 63%. In-house testing was performed in 17.6, 61.5, and 74.2% of the hospitals with < 300, 300 to 500, and > 500 beds, respectively. The average test positivity rates were 17.2, 15.3, and 13.2% for hospitals with < 300, 300 to 500, and > 500 beds, respectively. The average disease incidences were 23.5, 30.8, and 40.3 cases per 100,000 patient days in the hospitals with < 300, 300 to 500, and > 500 beds, respectively. In the 81 hospitals where in-house testing was performed, cytotoxin testing utilizing tissue culture was most common (44.4%), followed by enzyme-linked immunosorbent assay (38.3%), culture for toxigenic C. difficile (32.1%), and latex agglutination (13.6%). The clinical criteria for C. difficile testing were variable, with 85% of hospitals indicating that a test was done automatically if ordered by a doctor. Our results show that C. difficile-associated diarrhea is a major problem in hospitals with > or = 200 beds. Despite a lower disease incidence in smaller hospitals, there was a higher diagnostic test positivity rate. This may reflect the preference of smaller hospitals for culture and latex agglutination tests.
authors.affiliation: Department of Medical Microbiology, University of Manitoba, and St. Boniface General Hospital, Winnipeg, Canada. malfa@cc.umanitoba.ca
authors.forename: M J
authors.initials: MJ
authors.lastname: Alfa
authors.forename: T
authors.initials: T
authors.lastname: Du
authors.forename: G
authors.initials: G
authors.lastname: Beda
mesh_terms: D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000032:analysis; D001431:Bacteriological Techniques; D002170:Canada / Q000453:epidemiology; D016360:Clostridioides difficile / Q000254:growth & development / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology*; D003470:Culture Media; D003603:Cytotoxins / Q000032:analysis; D003625:Data Collection; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000453:epidemiology*; D004797:Enzyme-Linked Immunosorbent Assay; D006742:Hospital Bed Capacity; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007841:Latex Fixation Tests
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D003470:Culture Media; D003603:Cytotoxins; C031815:toxB protein, Clostridium difficile