title: Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals.
abstract: OBJECTIVE
  To assess the healthcare burden, morbidity, and mortality of nosocomial Clostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals.
  
  
  METHODS
  Laboratory-based prevalence study.
  
  
  METHODS
  Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program.
  
  
  METHODS
  Hospitalized patients in the participating centers.
  
  
  METHODS
  Laboratory-based surveillance was conducted for C. difficile toxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death.
  
  
  RESULTS
  We found that 371 (18%) of 2,062 tested patients had stools with positive results for C difficile toxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility.
  
  
  CONCLUSIONS
  N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.
authors.affiliation: SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Miller
authors.forename: Meagan
authors.initials: M
authors.lastname: Hyland
authors.forename: Marianna
authors.initials: M
authors.lastname: Ofner-Agostini
authors.forename: Marie
authors.initials: M
authors.lastname: Gourdeau
authors.forename: Magued
authors.initials: M
authors.lastname: Ishak
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D016360:Clostridioides difficile / Q000302:isolation & purification; D017281:Cost of Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011159:Population Surveillance; D015995:Prevalence