Recommendations for Surveillance of Clostridium difficile–Associated Disease

2007 ◽  
Vol 28 (2) ◽  
pp. 140-145 ◽  
Author(s):  
L. Clifford McDonald ◽  
Bruno Coignard ◽  
Erik Dubberke ◽  
Xiaoyan Song ◽  
Teresa Horan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Ad Hoc ◽  
Toxic Megacolon ◽  
Healthcare Facility ◽  
Case Patient ◽  
Healthcare Settings ◽  
Community Onset ◽  
Laboratory Assay

Background.The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and Methods.An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and Recommendations.A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

Population-Based Surveillance of Clostridium difficile Infection in Manitoba, Canada, by Using Interim Surveillance Definitions

2009 ◽  
Vol 30 (10) ◽  
pp. 945-951 ◽  
Author(s):  
Pascal J. Lambert ◽  
Myrna Dyck ◽  
Laura H. Thompson ◽  
Greg W. Hammond
Keyword(s):  
Nursing Home ◽  
Clostridium Difficile ◽  
Hospital Admission ◽  
Working Group ◽  
Surveillance System ◽  
Ad Hoc ◽  
Healthcare Facility ◽  
Population Based ◽  
Incident Cases ◽  
Community Onset

Objective.TO apply interim surveillance definitions of Clostridium difficile infection (CDI) cases to 1 year of data from the provincewide surveillance system of Manitoba, Canada, to determine the epidemiology of CDI incident cases in a population.Methods.CDI cases were categorized with interim surveillance definitions developed by an ad hoc C. difficile surveillance working group. Incident cases recorded in the provincial CDI database between July 2005 and June 2006 were linked to the provincial hospitalization and nursing home databases and analyzed.Results.One thousand six incident cases were identified over 1 year. Five hundred fifteen (51%) cases were associated with and began in a healthcare facility (HCF), whereas 275 (27%) were associated with and began in the community. An additional 131 (13%) cases were HCF associated but began in the community, while 85 (8%) were of indeterminate origin. Cases of HCF-associated CDI occurred in patients who were older than did cases of community-associated CDI (P < .0001). The provincial rate of community-onset cases was 23.4 per 100,000 person-years, and rates varied among geographic areas. HCF-associated CDI rates among the 10 largest hospitals varied from 0.5 to 8.4 per 10,000 patient-days. The time to CDI onset after hospital admission indicated that 25% of nosocomial cases began by the 8th day, and 50% began by the 17th day.Conclusions.Although the majority of CDI cases were associated with exposure to a HCF, 40% of incident CDI began in the community. Populations with HCF- and community-associated CDI demonstrated significantly different age distributions. The wide variation of rates among HCFs requires explanation. The high percentage of incident cases in the community warrants increased study.

scholarly journals Characterization of clinical Clostridium difficile isolates by PCR ribotyping and detection of toxin genes in Austria, 2006–2007

2008 ◽  
Vol 57 (6) ◽  
pp. 702-708 ◽  
Author(s):  
A. Indra ◽  
D. Schmid ◽  
S. Huhulescu ◽  
M. Hell ◽  
R. Gattringer ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Antimicrobial Agents ◽  
Toxic Megacolon ◽  
Health Care Facilities ◽  
Reference Laboratory ◽  
Specimen Collection ◽  
Pcr Ribotyping ◽  
High Level

In order to assess the lethality of Clostridium difficile-associated disease (CDAD) and the PCR ribotypes prevalent in Austria, the Austrian Agency for Health and Food Safety requested isolates of C. difficile from patients in a structured but arbitrary sampling scheme. In the allocated period from February 2006 to January 2007, local hospital laboratories within each of the nine provinces were asked to submit C. difficile isolates from at least ten cases of CDAD. Confirmation of species identification, toxin detection, susceptibility testing against four antimicrobial agents and typing using a PCR ribotyping method were performed at the reference laboratory. In total, 149 isolates of putative C. difficile were submitted, from which 142 were included for study. Antimicrobial susceptibility patterns revealed resistance to clindamycin in 57 % and high-level resistance to moxifloxacin in 38 % of isolates tested. CDAD manifested as diarrhoea (including eight cases of bloody diarrhoea) in 126 cases (88.7 %), as pseudomembranous colitis in 15 cases (10.6 %) and as toxic megacolon in one case. Twelve of the 142 patients died within 30 days of specimen collection (8.45 % lethality). A lethal outcome occurred in 2/15 cases (13.3 %) when pseudomembranous colitis was present and in 10/126 cases (7.9 %) in the absence of pseudomembranous colitis or toxic megacolon. Among the 142 isolates from 25 health-care facilities, 41 PCR ribotype patterns were found. The most frequent ribotypes were AI-5 (including six lethal cases out of 26 patients), 014 (two out of 24) and 053 (one out of 24). The typing patterns demonstrated the occurrence of clusters in hospitals.

Assessment of Clostridium difficile–Associated Disease Surveillance Definitions, North Carolina, 2005

2008 ◽  
Vol 29 (3) ◽  
pp. 197-202 ◽  
Author(s):  
Preeta K. Kutty ◽  
Stephen R. Benoit ◽  
Christopher W. Woods ◽  
Arlene C. Sena ◽  
Susanna Naggie ◽  
...  
Keyword(s):  
North Carolina ◽  
Clostridium Difficile ◽  
Disease Surveillance ◽  
Retrospective Cohort ◽  
Healthcare Facility ◽  
Catchment Areas ◽  
Toxin Assay ◽  
Definition Of ◽  
Community Onset ◽  
Modest Correlation

Objective.To determine the timing of community-onset Clostridium difficile–associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility–onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.Design.Retrospective cohort study for the period January 1, 2005, through December 31, 2005.Setting.Catchment areas of 6 acute care hospitals in North Carolina.Methods.We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin–assay results. Cases were classified as healthcare facility–onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility–associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility–onset, healthcare facility–associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases.Results.Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P<.001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included.Conclusions.A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility–associated CDAD that includes cases that occur within 4 weeks after discharge.

Complications of Hospital-Onset Healthcare Facility–Associated Clostridium difficile Infections Among Veterans

2016 ◽  
Vol 37 (6) ◽  
pp. 717-719 ◽  
Author(s):  
Martin E. Evans ◽  
Stephen M. Kralovic ◽  
Loretta A. Simbartl ◽  
Judith L. Whitlock ◽  
Rajiv Jain ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Acute Care ◽  
Healthcare Facility ◽  
Veterans Health Administration ◽  
Infect Control Hosp ◽  
Veterans Health ◽  
Health Administration ◽  
Infection Diagnosis

Complications within 30 days of a clinically confirmed hospital-onset Clostridium difficile infection diagnosis from July 1, 2012, through June 30, 2015, in 127 acute care Veterans Health Administration facilities were evaluated. Pooled rates for attributable intensive care unit admissions, colectomies, and deaths were 2.7%, 0.5%, and 0.4%, respectively.Infect Control Hosp Epidemiol 2016;37:717–719

scholarly journals An Assessment of 2016 National Healthcare Safety Network (NHSN) and National Electronic Disease Surveillance System (NEDSS) Clostridium difficile Infections (CDI) in Nebraska

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S399-S399
Author(s):  
Caitlin Pedati ◽  
Madison Sullivan ◽  
Margaret Drake ◽  
Alison Keyser ◽  
Tom Safranek ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Healthcare Facility ◽  
Data Sources ◽  
National Healthcare ◽  
Disease Surveillance System ◽  
Department Of Health ◽  
National Healthcare Safety Network ◽  
Community Onset

Abstract Background In 2016 all acute care hospitals, inpatient rehab facilities, and PPS-exempt cancer facilities in Nebraska were required to report laboratory identified (LabID) Clostridium difficile infections (CDIs) to the National Healthcare Safety Network (NHSN). Test results indicating CDIs must be reported to the Nebraska Department of Health and Human Services (NDHHS) via the National Electronic Disease Surveillance System (NEDSS). NHSN and NEDSS represent unique sources of CDI reports in Nebraska. Methods The NHSN Nebraska database was queried for CDIs reported in 2016. All lab tests indicating a CDI in 2016 were extracted from NEDSS. These extracts were analyzed to assess descriptive epidemiologic variables and compared for differences. Results In 2016 there were 1,546 CDI LabID events reported to NHSN Nebraska from 28 facilities. There were 249 outpatient CDIs and 1,297 inpatient CDIs. Infections were further characterized as community-onset (N = 773), community-onset, healthcare facility associated (N = 206), and hospital onset (N = 567). An average of 128 CDIs were reported per month (range: 111–155). In 2016 there were 2,177 lab results indicating a CDI reported to NEDSS among Nebraska residents from 42 facilities. Patient ages ranged from 4 months to 104 years (mean = 58 years). An average of 181 CDIs were reported per month (range: 151–218). Comparison of the two data sources found 781 reports among 591 unique patients at 11 facilities that were made to NHSN and were not in NEDSS. Additionally, there were 1,092 reports from 931 unique patients at 12 facilities that were made to NEDSS and should have been made to NHSN but were not. There were 9 shared facilities that accounted for the majority of these discrepancies. Conclusion NHSN and NEDSS represent two unique data sources that allow for a more comprehensive assessment of CDIs. The number and type of facility that report to each system is slightly different but there is some overlap. Therefore, this comparison allows for detection of a greater number of reports overall and also provides an opportunity for data validation. This assessment identified discrepancies in reporting among 9 facilities that can be targeted for further collaborative efforts to improve CDI reporting and management in Nebraska. Disclosures All authors: No reported disclosures.

Clostridium difficile Infections in Veterans Health Administration Acute Care Facilities

2014 ◽  
Vol 35 (8) ◽  
pp. 1037-1042 ◽  
Author(s):  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Rajiv Jain ◽  
Gary A. Roselle
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Hospital Admissions ◽  
Healthcare Facility ◽  
Resistant Organism ◽  
Veterans Health ◽  
Health Administration ◽  
Case Rate ◽  
Community Onset ◽  
Admission Prevalence

ObjectiveAn initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative.MethodsPersonnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module.ResultsThere were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility–associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility–associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively).ConclusionsVA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further.

scholarly journals COVID-19 and Fulminant Clostridium difficile Colitis Co-Infection

2021 ◽  
Author(s):  
Abdul Ahad Ehsan Sheikh ◽  
Abu Baker Sheikh ◽  
Ishan Shah ◽  
Ali Hamza Khair ◽  
Nismat Javed ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Toxic Megacolon ◽  
Healthcare Settings ◽  
Clostridium Difficile Colitis ◽  
Healthcare Associated

The development of Clostridium difficile infection in COVID-19 patients is an understudied complication of the disease. Herein, we present the case of a 46-year-old man who developed severe healthcare-associated C. difficile infection leading to toxic megacolon and perforation in the setting of COVID-19 infection. It is important to continue to follow guidelines regarding antibiotics in healthcare settings to prevent such complications.

scholarly journals Hospital-Associated Clostridium difficile Infection: Is It Necessary to Track Community-Onset Disease?

2009 ◽  
Vol 30 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kathleen M. McMullen ◽  
Jennie L. Mayfield ◽  
Kimberly A. Reske ◽  
Peter Georgantopoulos ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admission ◽  
Care Facility ◽  
Healthcare Facility ◽  
Generation Cephalosporin ◽  
Demographic Characteristics ◽  
Fourth Generation ◽  
Patient Demographic ◽  
Traditional Definition ◽  
Community Onset

Objectives.To compare Clostridium difficile infection (CDI) rates determined with use of a traditional definition (ie, with healthcare-onset CDI defined as diagnosis of CDI more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset CDI and community-onset CDI, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients with CDI onset in the community and those with CDI onset in a healthcare setting.Design.Prospective cohortSetting.Tertiary acute care facility.Patients.General medicine patients who received a diagnosis of CDI during the period January 1, 2004, through December 31, 2005.Methods.CDI was classified as healthcare-onset CDI, healthcare facility–associated CDI after hospitalization within the previous 30 days, and/or healthcare facility-associated CDI after hospitalization within the previous 60 days. Patient demographic characteristics and medication exposures were obtained. The CDI incidence with use of each definition, CDI rate variability, patient demographic characteristics, and medication exposures were compared.Results.The healthcare-onset CDI rate (1.6 cases per 1,000 patient-days) was significantly lower than the 30-day healthcare facility–associated CDI rate (2.4 cases per 1,000 patient-days; P<.01) and the 60-day healthcare facility–associated CDI rate (2.6 cases per 1,000 patient-days; P<.01). There was good correlation between the healthcare-onset CDI rate and both the 30-day (correlation, 0.69; P<.01) and 60-day (correlation, 0.70; P<.01) healthcare facility–associated CDI rates. There were no months in which the CDI rate was more than 3 standard deviations from the mean. Compared with patients with healthcare-onset CDI, patients with community-onset CDI were less likely to have received a fourth-generation cephalosporin (P = .02) or intravenous vancomycin (P = .01) during hospitalization.Conclusions.Compared with the traditional definition, expanded definitions identify more patients with CDI. There is good correlation between traditional and expanded CDI definitions; therefore, it is unclear whether expanded surveillance is necessary to identify an abnormal change in CDI rates. Cases that met the expanded definitions were less likely to have occurred in patients with fourth-generation cephalosporin and vancomycin exposure.

scholarly journals Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection

2009 ◽  
Vol 30 (6) ◽  
pp. 518-525 ◽  
Author(s):  
Erik R. Dubberke ◽  
Anne M. Butler ◽  
Bala Hota ◽  
Yosef M. Khan ◽  
Julie E. Mangino ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Control Charts ◽  
Healthcare Facility ◽  
The United States ◽  
Outbreak Detection ◽  
Multicenter Cohort Study ◽  
Time Points ◽  
Stool Samples ◽  
The Impact ◽  
Community Onset

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 I, 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.

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