title: Clostridium difficile infection in rural Ontario: a retrospective multisite population-based study.
abstract: BACKGROUND
  We conducted a retrospective, population-based study to assess the prevalence of Clostridium difficile infections and the associated risk factors among inpatients and outpatients in our region.
  
  
  METHODS
  We used laboratory data over a 2-year period to identify inpatient and outpatient cases of C. difficile infection. Data were collected from 3 local catchment areas for rural hospital laboratories in Sioux Lookout, Mount Forest and the South Huron Hospital Association in Exeter. We gathered demographic data and infection-specific information, including recent antibiotic use and recent or current hospital admission or nursing home stay.
  
  
  RESULTS
  During the study period, 34 cases of C. difficile infection occurred in 29 patients, with an estimated crude annual rate of 24.3/100,000 population. Of the cases, 47.1% were diagnosed in outpatients. Most patients (76.5%) had taken antibiotics within the previous 90 days, and antibiotic use and hospital admission accounted for 47.1% of cases. Clindamycin was more commonly associated with C. difficile infections at the northern site and ciprofloxacin at the southern sites. There were 2 deaths from comorbidities.
  
  
  CONCLUSIONS
  The estimated annual incidence of C. difficile infection in our study is similar to urban-based estimates. Almost half of the cases involved outpatients, indicating a need to recognize this illness as a serious outpatient condition. Antibiotic stewardship is an ongoing consideration, as most patients were exposed to antibiotic use before infection.
authors.affiliation: Department of Family Medicine, McMaster University, Mount Forest, Ont.
authors.forename: Ken
authors.initials: K
authors.lastname: Babey
authors.affiliation: Medical University of the Americas, Charlestown, Nevis, West Indies.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kelton
authors.affiliation: Department of Family Medicine, Western University, Exeter, Ont.
authors.forename: William K
authors.initials: WK
authors.lastname: Milne
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Jill
authors.initials: J
authors.lastname: Muileboom
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Brenda
authors.initials: B
authors.lastname: Voth
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
authors.affiliation: South Huron Hospital Association, Exeter, Ont.
authors.forename: William C
authors.initials: WC
authors.lastname: Brintnell
authors.affiliation: South Huron Hospital Association, Exeter, Ont.
authors.forename: Tammy
authors.initials: T
authors.lastname: Dickins
authors.affiliation: South Huron Hospital Association, Exeter, Ont.
authors.forename: Callie
authors.initials: C
authors.lastname: Armitage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002939:Ciprofloxacin