Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T07:40:26.609Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium difficile-Associated Disease in Oregon: Increasing Incidence and Hospital-Level Risk Factors

Published online by Cambridge University Press:  02 January 2015

Rebecca E. Chandler ,
Katrina Hedberg  and
Paul R. Cieslak
Rebecca E. Chandler
Affiliation:
Public Health Division, Department of Human Services, Portland, Oregon Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, Oregon
Katrina Hedberg
Affiliation:
Public Health Division, Department of Human Services, Portland, Oregon
Paul R. Cieslak*
Affiliation:
Public Health Division, Department of Human Services, Portland, Oregon
*
Acute and Communicable Disease Program, 800 NE Oregon St., Suite 772, Portland, OR 97232 (Paul.r.cieslak@state.or.us)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

The incidence of Clostridium difficile-associated disease (CDAD) appears to be increasing. Population-based estimates of disease have been limited, and analyses of hospital-level risk factors for CDAD are lacking. We sought to determine the incidence and trends of CDAD in Oregon and to identify hospital-level factors associated with increases in disease.

Methods.

We analyzed hospital discharge data to calculate the incidence and to describe trends of CDAD in Oregon from 1995 through 2002. We administered questionnaires to hospital laboratory directors, infection control practitioners, and pharmacists to determine the status of laboratory, infection control, and pharmacy policies over time.

Results.

The overall incidence of CDAD in Oregon was 3.5 case patients per 10,000 residents in 2002. Incidence increased from 1.4 to 3.3 cases per 1,000 hospital discharges from 1995 to 2002. Rates of disease increased most in hospitals with licensed bed capacity of more than 250 beds and more than 5 intensive care unit beds. Few laboratories, infection control practitioners, and pharmacists were able to identify changes in specific policies over the study period.

Conclusions.

This is the first study to determine a statewide population-based incidence of CDAD. Incidence of CDAD in Oregon has more than doubled over the past decade; larger hospitals experienced the greatest increase in disease rates. We did not identify hospital-level policies that could explain the increase. A study of patients with CDAD at the hospitals with the largest increases is underway to further identify risk factors.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 2 , February 2007 , pp. 116 - 122
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Riley, TV. The epidemiology of Clostridium difficile-associated diarrhoea. Rev Med Microbiol 1994;5:117–122.Google Scholar
2.Kelly, CP, Pothoulakis, C, LaMont, JT. Clostridium difficile colitis. N Engl J Med 1994;330:257–262.Google Scholar
3.Fekety, R, Shah, AB. Diagnosis and treatment of Clostridium difficile colitis. JAMA 1993;269:71–75.Google Scholar
4.Johnson, S, Gerding, DN. Clostridium difficile-associated diarrhea. Clin infect Dis 1998;26:1027–1036.Google Scholar
5.Spencer, RC. The role of antimicrobial agents in the aetiology of Clostridium difficile-associated disease. J Antimicrob Chemother 1998;41 (Suppl):21–27.Google Scholar
6.McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.Google Scholar
7.Samore, MH. Epidemiology of nosocomial Clostridium difficile diarrhoea. J Hosp Infect 1999;43(Suppl):S183–S190.Google Scholar
8.Olson, MM, Shanholzer, CJ, Lee, JTJ, Gerding, DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 1994;15:371–381.Google Scholar
9.Brown, E, Talbot, GH, Axelrod, P, Provencher, M, Hoegg, C. Risk factors for Clostridium difficile toxin-associated diarrhoea. Infect Control Hosp Epidemiol 1990;11:283–290.Google Scholar
10.Samore, MH, Bettin, KM, DeGirolami, PC, Clabots, CR, Gerding, DN, Karchmer, AW. Wide diversity of Clostridium difficile types at a tertiary referral hospital. J Infect Dis 1994;170:615–621.Google Scholar
11.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.Google Scholar
12.Struelens, MJ, Maas, A, Nonhoff, C, et al. Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance. Am J Med 1991;91:138S–144S.CrossRefGoogle ScholarPubMed
13.Karlstrom, O, Fryland, B, Tullus, K, Burman, G. A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 1998;26:141–145.CrossRefGoogle ScholarPubMed
14.Alfa, MJ, Du, T, Beda, G. Survey of incidence of Clostridium difficile infection in Canadian hospitals and diagnostic approaches. J Clin Microbiol 1998;36:2076–2080.Google Scholar
15.Thomas, C, Stevenson, M, Williamson, DJ, Riley, RV. Clostridium difficile-associated diarrhea: epidemiological data from western Australia associated with a modified antibiotic policy. Clin Infect Dis 2002;35:1457–1462.Google Scholar
16.McDonald, LC, Banerjee, SN, Jernigan, DB. Increasing incidence of Clostridium difficile-associated disease in US acute care hospitals. In: Program and abstracts of the Society for Hospital Epidemiology of America Annual Meeting, April 17, 2004-April 20, 2004. Philadelphia, PA. Abstract 67.Google Scholar
17.Pépin, J, Valiquette, L, Alary, M-E, Villemure, P, Pelletier, A, Forget, K, Pépin, K, Chouinard, D. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.Google Scholar
18.McFarland, LV, Surawicz, CM, Stamm, WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678–684.CrossRefGoogle Scholar
19.Kyne, L, Sougioultzis, C, McFarland, LV, Kelly, CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 2002;23:653–659.Google Scholar
20.Pierce, PF Jr, Wilson, R, Silva, J Jr, et al. Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases. J Infect Dis 1982;145:269–274.Google Scholar
21.Bliss, DZ, Johnson, S, Savik, K, Clabots, CR, Willard, K, Gerding, DN. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients who received tube feeding. Ann Intern Med 1998;129:1012–1019.Google Scholar
22.Anand, A, Glatt, AE. Clostridium difficile infection associated with antineoplastic chemotherapy: a review. Clin Infect Dis 1993;17:109–113.Google Scholar
23.Cunningham, R, Dale, B, Undy, B, Gaunt, N. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect 2003;54:243–245.Google Scholar
24.Portland State Population Research Center. Available at: http://www.upa.pdx.edu/CPRC/publications/annualorpopulation. Accessed August 30, 2004.Google Scholar
25.Kaiser State Health Facts Database. Available at: http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi. Accessed August 30, 2004.Google Scholar
26.Hirschhorn, LR, Trnka, Y, Onderdonk, A, Lee, M-LT, Platt, R. Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis 1994;169:127–133.Google Scholar
27.Frost, F, Hurley, JS, Petersen, HV, Casciano, RN. Estimated incidence of Clostridium difficile infection. Emerg Infect Dis 1999;5:302–303.Google Scholar
28.Kralovic, SM, Danko, LH, Simbartl, LA, Roselle, GA. Clostridium difficile infection in VA medical centers nationwide. In: Program and abstracts of the Society for Hospital Epidemiology of America Annual Meeting; April 9, 2005-April 12, 2005. Los Angeles, CA. Abstract 284.Google Scholar
29.Archibald, LK, Banerjee, SN, Jarvis, WR. Secular trends in hospital-acquired Clostridium difficile disease in the United Sates, 1987-2001. J Infect Dis 2004;189:1585–1589.Google Scholar
30.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
31.Barbut, F, Delmee, M, Brazier, JS, et al. A European survey of diagnostic methods and testing protocols for Clostridium difficile. ESCMID Study Group on Clostridium difficile. Clin Microbiol Infect 2003;9:989–996.Google Scholar
32.Clabots, CR, Gerding, SJ, Olson, MM, Peterson, LR, Gerding, DN. Detection of asymptomatic Clostridium difficile carriage by an alcohol shock procedure. J Clin Microbiol 1989;27:2386–2387.Google Scholar
33.McCusker, ME, Harris, AD, Perencevich, E, Roghmann, M. Fluoroquinolone use and Clostridium difficile-associated diarrhea. Emerg Infect Dis 2003;9:730–733.Google Scholar
34.Gaynes, R, Rimland, D, Killum, E, Lowery, K, Johnson, TM TM, Kilgore, G, Tenover, FC. Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 2004;38: 640-645.Google Scholar
35.Khan, R, Cheesbrough, J. Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhea over a five-year period in a district general hospital. J Hosp Infect 2003;54:104–108.Google Scholar
36.O'Connor, KA, Kingston, M, O'Donovan, M, Cryan, B, Twomey, C, O'Mahony, D. Antibiotic prescribing policy and Clostridium difficile diarrhea. QJM 2004;97:423–429.Google Scholar