title: Associations between nosocomial meticillin-resistant Staphylococcus aureus and nosocomial Clostridium difficile-associated diarrhoea in 89 German hospitals.
abstract: BACKGROUND
  Clostridium difficile is mainly considered as a hospital-acquired pathogen causing diarrhoea in healthcare settings.
  
  
  OBJECTIVE
  To quantify and compare the incidence density of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) and C. difficile-associated infection (CDI) in a network of German hospitals; also to assess whether there is an association between nosocomial MRSA and nosocomial CDI.
  
  
  METHODS
  Acute hospitals reported data on the number of patients, patient-days and MRSA and/or CDI cases to the German nosocomial infection surveillance system (KISS). Cases were classified as nosocomial or imported. Nosocomial incidences and incidence densities (per 1000 patient-days) of MRSA and CDI were calculated by Spearman correlation index.
  
  
  RESULTS
  In 2010, a total of 89 hospitals reported hospital-wide MRSA and CDI cases. The analysis included 1,536,031 patients, 11,138,496 patient-days, 5183 nosocomial CDI cases and 2233 nosocomial MRSA cases. The pooled incidence density of nosocomial CDI was 0.47, more than two-fold higher than that of nosocomial MRSA (0.20). Correlation of nosocomial incidences of MRSA and CDI was statistically significant [correlation coefficient (CC) of 0.515]. Correlation of incidence densities was likewise significant with a CC of 0.484.
  
  
  CONCLUSIONS
  The incidence of nosocomial CDI was twice as high as nosocomial MRSA incidence among our database and with the definitions used. High nosocomial MRSA or CDI cases might be indicators for deficits in infection control and/or selection pressure of antibiotics.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany. elisabeth.meyer@charite.de
authors.forename: E
authors.initials: E
authors.lastname: Meyer
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
authors.forename: D
authors.initials: D
authors.lastname: Weizel-Kage
authors.forename: F
authors.initials: F
authors.lastname: Schwab
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005858:Germany / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology