title: Clostridium difficile Infection Among Veterans Health Administration Patients.
abstract: OBJECTIVE
  To report on the prevalence and incidence of Clostridium difficile infection (CDI) from 2009 to 2013 among Veterans Healthcare Administration patients
  
  
  METHODS
  A retrospective descriptive analysis of data extracted from a large electronic medical record (EMR) database
  
  
  METHODS
  Data were acquired from VHA healthcare records from 2009 to 2013 that included outpatient clinical visits, long-term care, and hospitalized care as well as pharmacy and laboratory information.
  
  
  RESULTS
  In 2009, there were 10,207 CDI episodes, and in 2013, there were 12,143 CDI episodes, an increase of 19.0%. The overall CDI rate increased by 8.4% from 193 episodes per 100,000 patient years in 2009 to 209 episodes per 100,000 patient years in 2013. Of the CDI episodes identified in 2009, 58% were identified during a hospitalization, and 42% were identified in an outpatient setting. In 2013, 44% of the CDI episodes were identified in an outpatient setting.
  
  
  CONCLUSIONS
  This is one of the largest studies that has utilized timely EMR data to describe the current CDI epidemiology at the VHA. Despite an aging population with greater burden of comorbidity than the general US population, our data show that VHA CDI rates stabilized between 2011 and 2013 following increases likely attributable to the introduction of the more sensitive nucleic acid amplification tests (NAATs). The findings in this report will help establish an accurate benchmark against which both current and future VA CDI prevention initiatives can be measured.
authors.affiliation: 1National Center for Patient Safety,Department of Veterans Affairs,White River Junction,Vermont,United States.
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
authors.affiliation: 3Kaiser Permanente Northwest Center for Health Research,Portland,Oregon,United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kuntz
authors.affiliation: 4Edward Hines Jr. Veterans Affairs Hospital,Hines,Illinois and Loyola University Chicago Stritch School of Medicine,Maywood,Illinois,United States.
authors.forename: Dale N
authors.initials: DN
authors.lastname: Gerding
authors.affiliation: 1National Center for Patient Safety,Department of Veterans Affairs,White River Junction,Vermont,United States.
authors.forename: Julia
authors.initials: J
authors.lastname: Neily
authors.affiliation: 1National Center for Patient Safety,Department of Veterans Affairs,White River Junction,Vermont,United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Mills
authors.affiliation: 5Department of Medicine,Washington University School of Medicine,St. Louis,Missouri,United States.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.affiliation: 5Department of Medicine,Washington University School of Medicine,St. Louis,Missouri,United States.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.affiliation: 7Division of Gastroenterology,Beth Israel Deaconess Medical Center,Harvard Medical School,Boston,Massachusetts,United States.
authors.forename: Ciarán P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: 8Sanofi-Pasteur,Lyon,France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Mahé
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data* / Q000639:trends; D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology; D057286:Electronic Health Records; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data* / Q000639:trends; D055815:Young Adult