title: Clostridium difficile toxin testing by National Health Service (NHS) acute Trusts in England: 2008-2013.
abstract: In October 2007, a governmental 3-year target to reduce Clostridium difficile infection (CDI) by 30%, with financial penalties levied for failure, was introduced in England. This target was met within just 1 year, leading to speculation of 'gaming', with hospitals empirically treating possible CDI in the absence of a microbiological diagnosis, to avoid having to report confirmed cases. An analysis of aggregate mandatory data on levels of testing for C. difficile toxin showed little evidence of a fall in testing during the steepest infection rate reductions, suggesting that this was not a major factor in the decline in CDI.
authors.affiliation: HCAI and AMR Department, Infectious Disease Surveillance and Control, Health Protection, Public Health England, London, UK. Electronic address: sarah.gerver@phe.gov.uk.
authors.forename: S M
authors.initials: SM
authors.lastname: Gerver
authors.affiliation: HCAI and AMR Department, Infectious Disease Surveillance and Control, Health Protection, Public Health England, London, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: HCAI and AMR Department, Infectious Disease Surveillance and Control, Health Protection, Public Health England, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hope
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D004739:England / Q000453:epidemiology; D004760:Enterocolitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015995:Prevalence; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins
keywords: Clostridium difficile; England; objectives; stool samples; toxin testing