title: Mortality and Clostridium difficile infection in an Australian setting.
abstract: OBJECTIVE
  To quantify the risk of death associated with Clostridium difficile infection, in an Australian tertiary hospital.
  
  
  BACKGROUND
  Two reviews examining Clostridium difficile infection and mortality indicate that Clostridium difficile infection is associated with increased mortality in hospitalized patients. Studies investigating the mortality of Clostridium difficile infection in settings outside of Europe and North America are required, so that the epidemiology of Clostridium difficile infection in these regions can be understood and appropriate prevention strategies made.
  
  
  METHODS
  An observational non-concurrent cohort study design was used.
  
  
  METHODS
  Data from all persons who had (exposed) and a matched sample of persons who did not have Clostridium difficile infection, for the calendar years 2007-2010, were analysed. The risk of dying within 30, 60, 90 and 180 days was compared using the two groups. Kaplan-Meier survival analysis and conditional logistic regression models were applied to the data to examine time to death and mortality risk adjusted for comorbidities using the Charlson Comorbidity Index.
  
  
  RESULTS
  One hundred and fifty-eight cases of infection were identified. A statistically significant difference in all-cause mortality was identified between exposed and non-exposed groups at 60 and 180 days. In a conditional regression model, mortality in the exposed group was significantly higher at 180 days.
  
  
  CONCLUSIONS
  In this Australian study, Clostridium difficile infection was associated with increased mortality. In doing so, it highlights the need for nurses to immediately instigate contact precautions for persons suspected of having Clostridium difficile infection and to facilitate a timely faecal collection for testing. Our findings support ongoing surveillance of Clostridium difficile infection and associated prevention and control activities.
authors.affiliation: School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia.
authors.forename: Brett G
authors.initials: BG
authors.lastname: Mitchell
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D003967:Diarrhea / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D013648:Tasmania / Q000453:epidemiology
keywords: Australia; Clostridium difficile infection; Clostridium difficile-associated diarrhoea; death; healthcare-associated infection; infection control; mortality; nurse; nursing