NDLI: Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. difficile infection.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Dubberke, Erik R. Butler, Anne M. Hota, Bala Khan, Yosef M. Mangino, Julie E. Mayer, Jeanmarie Popovich, Kyle J. Stevenson, Kurt B. Yokoe, Deborah S. McDonald, L. Clifford Jernigan, John Fraser, Victoria J.
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Dubberke ER ( Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA. edubberk@im.wustl.edu)
Abstract	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 (rho 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 ((kappa = 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.
File Format	HTM / HTML
ISSN	0899823X
e-ISSN	15596834
DOI	10.1086/597380
Journal	Infection Control & Hospital Epidemiology
Issue Number	6
Volume Number	30
Language	English
Publisher	Cambridge University Press
Publisher Date	2009-06-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Communicable Diseases Discipline Epidemiology Clostridium Difficile Isolation & Purification Community-acquired Infections Epidemiology Cross Infection Disease Outbreaks Enterocolitis, Pseudomembranous Sentinel Surveillance Cohort Studies Microbiology Hospitals, University Statistics & Numerical Data Multicenter Study Research Support, N.i.h., Extramural Research Support, U.s. Gov't, P.h.s.
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Epidemiology Microbiology (medical)

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