CDI May Be a Regional Challenge

Researchers from the Prevention Epicenters Program at the Centers for Disease Control and Prevention (CDC) say that increasing Clostridium difficile infection (CDI) rates could suggest that it is a regional problem and not merely a challenge isolated to a single healthcare institution within a community. Their research was published in the October issue of Infection Control and Hospital Epidemiology.

Dubberke, et al. (2010) sought to compare CDI incidence rates during a six-year period among five academic medical centers across the country, using recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare institution exposure.

The researchers collected data on C. difficile toxin assay results and dates of hospital admission and discharge from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any healthcare institution exposure during the 90 days prior to their admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into five surveillance definitions based on recent healthcare facility exposure. Annual CDI rates were calculated and evaluated by use of the 2 test for trend and the 2 summary test.

Dubberke, et al. (2010) report that during the study period, there were significant increases in the overall incidence rates of healthcare facility-onset and healthcare facility-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days); community-onset, healthcare facility associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days); and community-onset, healthcare facility-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall ). For each surveillance definition of CDI, there were significant differences in the total incidence rate between healthcare institutions, they add.

The researchers conclude that increasing incidence rates of CDI over time and across healthcare institutions , as well as the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single healthcare facility within a community.

Reference: Dubberke ER, Butler AM, Yokoe DS, Mayer J, Hota B, Mangino JE, Khan YM, Popovich KJ and Fraser VJ. Multicenter Study of Clostridium difficile Infection Rates from 2000 to 2006. Infect Control Hosp Epidemiol. 2010;31:10301037.