TY - JOUR
T1 - Multicenter study of the impact of community-onset clostridium difficile infection on surveillance for C. difficile infection
AU - Dubberke, Erik R.
AU - Butler, Anne M.
AU - Hota, Bala
AU - Khan, Yosef M.
AU - Mangino, Julie E.
AU - Mayer, Jeanmarie
AU - Popovich, Kyle J.
AU - Stevenson, Kurt B.
AU - Yokoe, Deborah S.
AU - Mcdonald, L. Clifford
AU - Jernigan, John
AU - Fraser, Victoria J.
PY - 2009/6
Y1 - 2009/6
N2 - objective. To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI. design. A retrospective multicenter cohort study. setting. Five university-affiliated, acute care HCFs in the United States. methods. We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July 1, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks. results. The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P<.01 ). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (ρ range, 0.94-0.99; P <.001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (k=0.794; P <.001). Conclusions. Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.
AB - objective. To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI. design. A retrospective multicenter cohort study. setting. Five university-affiliated, acute care HCFs in the United States. methods. We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July 1, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks. results. The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P<.01 ). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (ρ range, 0.94-0.99; P <.001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (k=0.794; P <.001). Conclusions. Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.
UR - http://www.scopus.com/inward/record.url?scp=67651083561&partnerID=8YFLogxK
U2 - 10.1086/597380
DO - 10.1086/597380
M3 - Article
C2 - 19419269
AN - SCOPUS:67651083561
SN - 0899-823X
VL - 30
SP - 518
EP - 525
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 6
ER -