Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003

L Clifford McDonald, Maria Owings, Daniel B Jernigan, L Clifford McDonald, Maria Owings, Daniel B Jernigan

Abstract

US hospital discharges for which Clostridium difficile-associated disease (CDAD) was listed as any diagnosis doubled from 82,000 (95% confidence interval [CI] 71,000-94,000) or 31/100,000 population in 1996 to 178,000 (95% CI 151,000-205,000) or 61/100,000 in 2003; this increase was significant between 2000 and 2003 (slope of linear trend 9.48; 95% CI 6.16-12.80, p = 0.01). The overall rate during this period was severalfold higher in persons >65 years of age (228/100,000) than in the age group with the next highest rate, 45-64 years (40/100,000; p < or = 0.001). CDAD appears to be increasing rapidly in the United States and is disproportionately affecting older persons. Clinicians should be aware of the increasing risk for CDAD and make efforts to control transmission of C. difficile and prevent disease.

Figures

Figure 1
Figure 1
National estimates of US short-stay hospital discharges with Clostridium difficile listed as primary or as any diagnosis. Isobars represent 95% confidence intervals.
Figure 2
Figure 2
Rates of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by age. Isobars represent 95% confidence intervals. Because of low rates and the resulting uncertainty of yearly rate estimates, data for patients <15 years of age are not included.
Figure 3
Figure 3
Rates of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by region. Northeast (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Pennsylvania), Midwest (Indiana, Illinois, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota), South (Delaware, Washington DC, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma, Texas), and West (Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, Wyoming, Alaska, California, Oregon, Washington, Hawaii) regions as defined by US Census Bureau.
Figure 4
Figure 4
Proportion of US short-stay hospital discharges with Clostridium difficile listed as any diagnosis, by hospital size (number of beds).

References

    1. Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile–associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16:459–77. 10.1086/648363
    1. Siemann M, Koch-Dorfler M, Rabenhorst G. Clostridium difficile-associated diseases. The clinical courses of 18 fatal cases. Intensive Care Med. 2000;26:416–21. 10.1007/s001340051175
    1. Simor AE, Bradley SF, Strausbaugh LJ, Crossley K, Nicolle LE. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol. 2002;23:696–703. 10.1086/501997
    1. Kyne L, Merry C, O'Connell B, Keane C, O'Neill D. Community-acquired Clostridium difficile infection. J Infect. 1998;36:287–8. 10.1016/S0163-4453(98)94207-4
    1. Johnson S, Samore MH, Farrow KA, Killgore GE, Tenover FC, Lyras D, et al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med. 1999;341:1645–51. 10.1056/NEJM199911253412203
    1. Kato H, Kato N, Watanabe K, Yamamoto T, Suzuki K, Ishigo S, et al. Analysis of Clostridium difficile isolates from nosocomial outbreaks at three hospitals in diverse areas of Japan. J Clin Microbiol. 2001;39:1391–5. 10.1128/JCM.39.4.1391-1395.2001
    1. Kyne L, Hamel MB, Polavaram R, Kelly CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis. 2002;34:346–53. 10.1086/338260
    1. Spencer RC. Clinical impact and associated costs of Clostridium difficile–associated disease. J Antimicrob Chemother. 1998;41(Suppl C):5–12. 10.1093/jac/41.suppl_3.5
    1. Gaynes R, Rimland D, Killum E, Lowery HK, Johnson TM, Killgore G, et al. Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis. 2004;38:640–5. 10.1086/381551
    1. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg. 2002;235:363–72. 10.1097/00000658-200203000-00008
    1. Morris AM, Jobe BA, Stoney M, Sheppard BC, Deveney CW, Deveney KE. Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Arch Surg. 2002;137:1096–100. 10.1001/archsurg.137.10.1096
    1. Archibald LK, Banerjee SN, Jarvis WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987–2001. J Infect Dis. 2004;189:1585–9. 10.1086/383045
    1. Kozak LJ, Owings MF, Hall MJ. National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2004;156:1–198.
    1. Shah B, Barnwell B, Bieler G. SUDAAN Users' Manual, Release 7.0. Research Triangle Park (NC): Research Triangle Institute; 1996.
    1. Gillum BS, Graves EJ, Jean L. Trends in hospital utilization: United States, 1988–92. Vital Health Stat 13. 1996;124:1–71.
    1. Dubberke ER, Reske KA, McDonald LC, Fraser VJ. Evaluation of methods to identify patient with Clostridium difficile–associated disease from data obtained through electronic databases: ICD-9 codes versus laboratory toxin results. Proceedings of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, Los Angeles, California, April 9–12, 2005. Abstract 283. Alexandria (VA): Slack Inc.; 2005.
    1. Kralovic SM, Danko LH, Simbartl MS, Roselle GA. Clostridium difficile infection in VA medical centers nationwide. Proceedings of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, Los Angeles, California, April 9–12, 2005. Abstract 284. Alexandria (VA): Slack Inc.; 2005.
    1. Microbiology Resource Committee, College of American Pathologists. Bacterial antigen detection (SE-D-1998 through SE-D-2003) participant surveys. Northfield (IL): College of American Pathologists; 2005. [cited 2006 Jan 22]. Available from
    1. Delmee M, Van Broeck J, Simon A, Janssens M, Avesani V. Laboratory diagnosis of Clostridium difficile–associated diarrhea: a plea for culture. J Med Microbiol. 2005;54:187–91. 10.1099/jmm.0.45844-0
    1. Johnson S, Kent SA, O'Leary KJ, Merigan MM, Sambol SP, Peterson LR, et al. Fatal pseudomembranous colitis associated with a variant Clostridium difficile strain not detected by toxin A immunoassay. Ann Intern Med. 2001;135:434–8.
    1. Barbut F, Lalande V, Burghoffer B, Thien HV, Grimprel E, Petit J-C. Prevalence and genetic characterization of toxin A variant strains of Clostridium difficile among adults and children with diarrhea in France. J Clin Microbiol. 2002;:2079–83. 10.1128/JCM.40.6.2079-2083.2002
    1. Kuehnert MJ, Hill HA, Kupronis BA, Tokars JI, Solomon SL, Jernigan DB. Methicillin-resistant Staphylococcus aureus–related hospitalizations, United States. Emerg Infect Dis. 2005;11:868–72.
    1. Panlilio AL, Culver DH, Gaynes RP, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975–1991. Infect Control Hosp Epidemiol. 1992;13:582–6. 10.1086/646432
    1. Yip C, Loeb M, Salama S, Moss L, Olde J. Quinolone use as a risk factor for nosocomial Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol. 2001;22:572–5. 10.1086/501954
    1. McCusker ME, Harris AD, Perencevich E, Roghmann MC. Fluoroquinolone use and Clostridium difficile–associated diarrhea. Emerg Infect Dis. 2003;9:730–3.
    1. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002;23(Suppl):S3–40. 10.1086/503164
    1. Samore M, Killgore G, Johnson S, Goodman R, Shim J, Venkataraman L, et al. Multicenter typing comparison of sporadic and outbreak Clostridium difficile isolates from geographically diverse hospitals. J Infect Dis. 1997;176:1233–8. 10.1086/514117
    1. McDonald LC, Killgore GE, Thompson A, Owens RC, Kazakova SV, Sambol SP, et al. Emergence of an epidemic, toxin gene variant strain of Clostridium difficile responsible for outbreaks in the United States between 2000 and 2004. N Engl J Med. 2005;353:2433–41. 10.1056/NEJMoa051590
    1. McDonald LC. Clostridium difficile: responding to a new threat from an old enemy. Infect Control Hosp Epidemiol. 2005;26:672–5. 10.1086/502600
    1. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079–84. 10.1016/S0140-6736(05)67420-X
    1. Gurian L, Ward TT, Katon RM. Possible foodborne transmission in a case of pseudomembranous colitis due to Clostridium difficile: influence of gastrointestinal secretions on Clostridium difficile infection. Gastroenterology. 1982;83:465–9.
    1. Cunningham R, Dale B, Undy B, Gaunt N. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect. 2003;54:243–5. 10.1016/S0195-6701(03)00088-4
    1. Sambol SP, Merrigan MM, Tang JK, Johnson S, Gerding DN. Colonization for the prevention of Clostridium difficile disease in hamsters. J Infect Dis. 2002;186:1781–9. 10.1086/345676
    1. Shim JK, Johnson S, Samore MH, Bliss DZ, Gerding DN. Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet. 1998;351:633–6. 10.1016/S0140-6736(97)08062-8
    1. Wilcox MH. Descriptive study of intravenous immunoglobulin for the treatment of recurrent Clostridium difficile diarrhoea. J Antimicrob Chemother. 2004;53:882–4. 10.1093/jac/dkh176
    1. Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342:390–7. 10.1056/NEJM200002103420604
    1. Giannasca PJ, Warny M. Active and passive immunization against Clostridium difficile diarrhea and colitis. Vaccine. 2004;22:848–56. 10.1016/j.vaccine.2003.11.030
    1. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17:53–80. 10.1086/647190

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren