title: Epidemiology of Clostridium difficile infection in two tertiary-care hospitals in Perth, Western Australia: a cross-sectional study.
abstract: The epidemiology of Clostridium difficile infection (CDI) has changed over time and between countries. It is therefore essential to monitor the characteristics of patients at risk of infection and the circulating strains to recognize local and global trends, and improve patient management. From December 2011 to May 2012 we conducted a prospective, observational epidemiological study of patients with laboratory-confirmed CDI at two tertiary teaching hospitals in Perth, Western Australia to determine CDI incidence and risk factors in an Australian setting. The incidence of CDI varied from 5.2 to 8.1 cases/10 000 occupied bed days (OBDs) at one hospital and from 3.9 to 16.3/10 000 OBDs at the second hospital. In total, 80 patients with laboratory-confirmed CDI met eligibility criteria and consented to be in the study. More than half (53.8%) had hospital-onset disease, 28.8% had community-onset and healthcare facility-associated disease and 7.5% were community-associated infections according to the definitions used. Severe CDI was observed in 40.0% of these cases but the 30-day mortality rate for all cases was only 2.5%. Besides a shorter length of stay among cases of community-onset CDI, no characteristics were identified that were significantly associated with community-onset or severe CDI. From 70 isolates, 34 different ribotypes were identified. The predominant ribotypes were 014 (24.3%), 020 (5.7%), 056 (5.7%) and 070 (5.7%). Whereas this study suggests that the characteristics of CDI cases in Australia are not markedly different from those in other developed countries, the increase in CDI rate observed emphasizes the importance of surveillance.
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia Perth, Western Australia, Australia.
authors.forename: N F
authors.initials: NF
authors.lastname: Foster
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia Perth, Western Australia, Australia.
authors.forename: D A
authors.initials: DA
authors.lastname: Collins
authors.affiliation: Sir Charles Gairdner Hospital Perth, Western Australia, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Ditchburn
authors.affiliation: Sir Charles Gairdner Hospital Perth, Western Australia, Australia.
authors.forename: C N
authors.initials: CN
authors.lastname: Duncan
authors.affiliation: Sir Charles Gairdner Hospital Perth, Western Australia, Australia.
authors.forename: J W
authors.initials: JW
authors.lastname: van Schalkwyk
authors.affiliation: Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre Perth, Western Australia, Australia.
authors.forename: C L
authors.initials: CL
authors.lastname: Golledge
authors.affiliation: Department of Infectious Diseases and Microbiology, Royal Perth Hospital Perth, Western Australia, Australia.
authors.forename: A B R
authors.initials: AB
authors.lastname: Keed
authors.affiliation: School of Pathology and Laboratory Medicine, The University of Western Australia Perth, Western Australia, Australia ; Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre Perth, Western Australia, Australia.
authors.forename: T V
authors.initials: TV
authors.lastname: Riley
keywords: Community-associated Clostridium difficile infection; healthcare facility-associated Clostridium difficile infection; molecular epidemiology; ribotype 244