title: Nosocomial and non-nosocomial Clostridium difficile infections in hospitalised patients in Belgium: compulsory surveillance data from 2008 to 2010.
abstract: Surveillance of Clostridium difficile infection (CDI) is compulsory in Belgian hospitals. Our objectives were to compare incidence and case characteristics of nosocomial infections (Nc-CDI) with onset of diarrhoea more than two days after hospital admission, with non-nosocomial cases (Nnc-CDI). The database included inpatients from 2008 to 2010. Of 8,351 cases reported by 150 hospitals, 3,102 (37%) were classified as Nnc-CDI and 5,249 (63%) as Nc-CDI. In 2010, the mean incidence per 1,000 admissions was 0.95 for Nc-CDI and 0.56 for Nnc-CDI. Both incidences were relatively stable over the three years, with a slight decrease in 2010 (p<0.01). Onset of symptoms in Nnc- CDI cases took place in the community (57.1%), nursing homes (14.2%) or hospitals (17.5%); data for 11.2%were missing. Nnc-CDI cases were younger than Nc-CDI (median age 75 vs. 79 years, p<0.001), and more likely to be women (62% vs. 57%, p<0.001) and to have pseudomembranous colitis (5.3% vs. 1.6%, p<0.001). In 2009, C. difficile ribotype 027 was found in 32 of 70 reporting hospitals compared with 19 of 69 in 2010 (p<0.03). Although our study population only included hospitalised patients, the results do not support the hypothesis of an increase in the incidence of severe community-associated CDI.
authors.affiliation: Public Health and Surveillance Department, Scientific Institute for Public Health, Brussels, Belgium. natacha.viseur@wiv-isp.be
authors.forename: N
authors.initials: N
authors.lastname: Viseur
authors.forename: Ml
authors.initials: M
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: Delmee
authors.forename: J
authors.initials: J
authors.lastname: Van Broeck
authors.forename: B
authors.initials: B
authors.lastname: Catry
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D016360:Clostridioides difficile / Q000145:classification / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D021521:Ribotyping