title: Secular trends in the epidemiology of Clostridium difficile infection (CDI): relationship with alcohol gel and antimicrobial usage in a hospital.
abstract: BACKGROUND
  Clostridium difficile-associated diarrhea (CDAD) has shown increasing incidence, morbidity, and mortality in recent years. We assessed the number of CDAD tests requested, CDAD positivity rates, the use of alcohol-based hand rubs, and antimicrobial utilization.
  
  
  METHODS
  We collected information on every adult patient (>18 years) who developed diarrhea and had a positive stool test for C. difficile toxin from June 2005 to December 2009 at a tertiary care hospital. A time-series analysis was performed using monthly data on the incidence of C. difficile infection (CDI) (i.e., cases of infection per 1000 patient-days), as well as the consumption of alcohol-based hand rubs (in liters/1000-patient days) and antibiotics (in defined daily doses per 1000 patient-days).
  
  
  RESULTS
  The mean number of annual requests for C. difficile tests was 1031, and the rates per 1000 patient-days for each year from 2005 to 2009 were 0.30, 0.46, 0.39, 0.31, and 0.40 overall in the hospital, and 0.18, 0.10, 0.53, 0.38, and 0.37 in the intensive care unit (ICU). The use of alcohol-based hand rubs per 1000 patient-days increased from 37.4 to 73.0, and from 41.5 to 129.4 in the hospital and in the ICU, respectively.
  
  
  CONCLUSIONS
  The incidence of CDI in the hospital and ICU remained low, despite the increased use of alcohol-based hand rubs and antimicrobials.
authors: Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5° Andar - Bloco B, São Paulo, CEP 05651-901, Brazil. moacyrjunior8@hotmail.com
authors: Moacyr
authors: M
authors: Silva
authors: Alexandre Rodrigues
authors: AR
authors: Marra
authors: Thiago Zinsly Sampaio
authors: TZ
authors: Camargo
authors: Silvana Maria de
authors: SM
authors: Almeida
authors: Itacy
authors: I
authors: Siqueira
authors: Luci
authors: L
authors: Correa
authors: Julia Yaeko
authors: JY
authors: Kawagoe
authors: Oscar Fernando Pavão
authors: OF
authors: dos Santos
authors: Michael B
authors: MB
authors: Edmond
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000438:Alcohols; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects; D003428:Cross Infection; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D004202:Disinfectants; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D063373:Hand Hygiene; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000438:Alcohols; D000890:Anti-Infective Agents; D004202:Disinfectants