title: Monitoring Clostridium difficile infection in an acute hospital: prevalence or incidence studies?
abstract: BACKGROUND
  Surveillance of Clostridium difficile infection (CDI) is an essential component of a CDI preventative programme.
  
  
  OBJECTIVE
  The aim of this study was to evaluate two methods of CDI surveillance.
  
  
  METHODS
  Prevalence of CDI, antibiotic use and associated co-morbidity was assessed weekly on two wards over 6 weeks. In addition, CDI incidence surveillance was performed on all new CDI cases over a 13-week period. Cases were assessed for CDI risk factors, disease severity, response to treatment and outcome at 6 months.
  
  
  RESULTS
  Clostridium difficile infection prevalence was 3.5% (range 2.9-6.1%) on the medical ward and 1.1% (range 0-3.5%) on the surgical ward. Patients on the medical ward were older and more likely to be colonised with MRSA; however, recent antibiotic use was more prevalent among surgical patients. Sixty-one new CDI cases were audited. Patients were elderly (mean age 71 years) with significant co-morbidity (median age adjusted Charlson co-morbidity score 5). CDI ribotypes included 027 (29 cases) 078 (5) and 106 (4). Eight patients developed severe CDI, seven due to 027. Antibiotic use was common with 56% receiving three or more antibiotics in the preceding 8 weeks. Twenty-four patients had died at 6 months, five due to CDI.
  
  
  CONCLUSIONS
  Clostridium difficile infection prevalence gives a broad overview of CDI and points to areas that require more detailed surveillance and requires little time. However, patient-based CDI incidence surveillance provides a more useful analysis of CDI risk factors, disease and outcome for planning preventative programmes and focusing antibiotic stewardship efforts.
authors.affiliation: Department of Surgery, Beaumont Hospital, Smurfit Building, Dublin 9, Ireland. amandalavan@gmail.com
authors.forename: A H
authors.initials: AH
authors.lastname: Lavan
authors.forename: D P
authors.initials: DP
authors.lastname: McCartan
authors.forename: M M
authors.initials: MM
authors.lastname: Downes
authors.forename: A D K
authors.initials: AD
authors.lastname: Hill
authors.forename: F
authors.initials: F
authors.lastname: Fitzpatrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents