Preventing Clostridium difficile Infections

Results

The Emerging Infections Program population under surveillance included persons in the catchment areas of 111 acute-care hospitals and 310 nursing homes. A total of 10,342 CDIs were identified; 44% of patients were aged <65 years. CDIs were classified by inpatient or outpatient status at time of stool collection and type/location of exposures (Figure 1). Overall, 94% of all CDIs were related to various precedent and concurrent health-care exposures; of these, 75% had their onset outside of hospitals. In addition, some cases occurred in patients who were exposed to multiple settings. For example, 20% of hospital-onset CDIs occurred in recent (i.e., <12 weeks) residents of a nursing home, and 67% of nursing home–onset CDI cases occurred in patients recently discharged from an acute-care hospital.

(Enlarge Image)

Figure 1.

Percentage of Clostridium difficile infection (CDI) cases (N = 10,342), by inpatient or outpatient status at time of stool collection and type/location of exposures* — United States, Emerging Infections Program, 2010
CDIs were classified by inpatient or outpatient status at time of stool collection and type/location of exposures. Overall, 94% of all CDIs were related to various antecedent and concurrent health-care exposures; of these, 75% had their onset outside of hospitals. In addition, some cases occurred in patients who were exposed to multiple settings. For example, 20% of hospital-onset CDIs occurred in recent (i.e., <12 weeks) residents of a nursing home, and 67% of nursing home-onset CDI cases occurred in patients recently discharged from an acute-care hospital.

A total of 711 acute care hospitals in 28 states conducted facility-wide inpatient LabID-CDI event reporting to NHSN in 2010 (Table 1). A total of 42,157 incident LabID-CDI events were reported (Figure 2). Overall, 52% of LabID-CDI events were already present on admission to hospitals. The pooled rate of hospital-onset CDI was 7.4 per 10,000 patient-days, with a median hospital rate of 5.4 per 10,000 and an interquartile range of 6.2.

(Enlarge Image)

Figure 2.

Percentage of laboratory-identified Clostridium difficile infections (N = 42,157), by hospitalization status at time of stool collection and type/location of exposure — United States, National Healthcare Safety Network, 2010
From reporting hospital during the preceding 4 weeks.

The pooled hospital-onset CDI rate across the three prevention programs declined 20%, from 9.3 per 10,000 patient-days during the early comparison period to 7.5 during the later comparison period (rate ratio: 0.80) (Table 2).

Table 1. Number and percentage of hospitals reporting laboratory-identified *Clostridium difficile* infections, by selected characteristics — United States, National Healthcare Safety Network, 2010
Characteristic	No.	(%)
Total	711	(100)
Bed size
≤200	429	(61)
201–500	232	(33)
501–1000	46	(6)
>1000	1	(<0.5)
Medical school affiliation	226	(31)
Primary diagnostic assay used
Enzyme immunoassay for toxin A and/or B	364	(51)
Nucleic acid amplification test	238	(33)
Other	88	(12)
Missing data	21	(3)

Table 2. Reductions in hospital-onset *Clostridium difficile* infection rates — Illinois, Massachusetts, and New York, May 2008–October 2011*
State	Period	Patient days	Rate	(95% CI*)	Rate ratio	(95% CI)
Illinois	Mar 2010–Oct 2010	637,135	11.6	(10.3–13.0)	0.84	(0.70–1.00)
Illinois	Mar 2011–Oct 2011	578,121	9.9	(8.4–11.4)
Massachusetts	Feb 2010–Sep 2010	823,939	7.6	(6.7–8.5)	0.75	(0.63–0.90)
Massachusetts	Feb 2011–Sep 2011	830,023	5.7	(4.9–6.5)
New York	May 2008–Dec 2008	2,607,464	9.2	(8.5–9.9)	0.81	(0.73–0.89)
New York	May 2009–Dec 2009	2,575,514	7.5	(7.0–8.0)
Overall	Pooled baseline	4,068,538	9.3	(8.7–9.8)	0.80	(0.73–0.86)
Overall	Pooled post	3,983,658	7.5	(7.0–7.9)

Abbreviation: CI = confidence interval.
* Study periods vary by state.

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

My Alerts