Multicenter study of Clostridium difficile infection rates from 2000 to 2006.
OBJECTIVE
To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.


METHODS
Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the chi(2) test for trend and the chi(2) summary test.


RESULTS
During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.


CONCLUSIONS
The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.
Dubberke
Erik R
ER
Department of Medicine, Washington University School of Medicine, Box 8051, 660 South Euclid, St Louis, MO 63110, USA. edubberk@im.wustl.edu
Butler
Anne M
AM
Yokoe
Deborah S
DS
Mayer
Jeanmarie
J
Hota
Bala
B
Mangino
Julie E
JE
Khan
Yosef M
YM
Popovich
Kyle J
KJ
Fraser
Victoria J
VJ
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D010351:Patient Discharge; D011159:Population Surveillance / Q000379:methods; D014481:United States / Q000453:epidemiology; D055815:Young Adult