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Morbidity, Mortality, and Healthcare Burden of Nosocomial Clostridium Difficile-Associated Diarrhea in Canadian Hospitals

Published online by Cambridge University Press:  02 January 2015

Mark A. Miller ,
Meagan Hyland ,
Marianna Ofner-Agostini ,
Marie Gourdeau ,
Magued Ishak ,
Canadian Hospital Epidemiology Committee  and
Canadian Nosocomial Infection Surveillance Program
Mark A. Miller
Affiliation:
SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada
Meagan Hyland
Affiliation:
Health Canada, Ottawa, Ontario, Canada
Marianna Ofner-Agostini*
Affiliation:
Health Canada, Ottawa, Ontario, Canada
Marie Gourdeau
Affiliation:
Centre Hospitalier de l'Enfant Jésus, Quebec City, Quebec, Canada
Magued Ishak
Affiliation:
Centre Hospitalier Verdun, Montreal, Quebec, Canada
*
Division of Nosocomial and Occupational Infections, Centre for Infectious Disease Prevention and Control, Population and Public Health Branch, LCDC Building, 3rd Floor, Postal Locator 060E31, Ottawa, K1A 0L2 Ontario, Canada
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Abstract

Objective:

To assess the healthcare burden, morbidity, and mortality of nosocomial Clostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals.

Design:

Laboratory-based prevalence study.

Setting:

Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program.

Patients:

Hospitalized patients in the participating centers.

Methods:

Laboratory-based surveillance was conducted for C. difficile toxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death.

Results:

We found that 371 (18%) of 2,062 tested patients had stools with positive results for C. difficile toxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility.

Conclusion:

N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 3 , March 2002 , pp. 137 - 140
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989:320:204–210.CrossRefGoogle ScholarPubMed
2.Silva, J Jr. Clostridium difficile nosocomial infections: still lethal and persistent. Infect Control Hosp Epidemiol 1994;15:368–370.CrossRefGoogle ScholarPubMed
3.Olson, MM, Shanholtzer, MT, Lee, JT Jr, Gerding, DN. Ten years of prospective Clostridiumdifficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 1994;15:371–381.CrossRefGoogle Scholar
4.Manian, FA, Meyer, L. CDAD rates. Infect Control Hosp Epidemiol 1995; 16:63–65.CrossRefGoogle ScholarPubMed
5.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.CrossRefGoogle ScholarPubMed
6.Wilcox, MH, Smyth, ET. Incidence and impact of Clostridium difficile infection in the UK, 1993-1996. J Hosp Infect 1998;39:181–187.CrossRefGoogle ScholarPubMed
7.Hyland, M, Ofner-Agostini, ME, Miller, MA, Paton, S, Gourdeau, M, Ishak, M. Nosocomial Clostridium difficile-associated diarrhea in Canada: the results of the Canadian Nosocomial Infection Surveillance Program (CNISP) 1997 N-CDAD prevalence surveillance project. Canadian Journal of Infectious Diseases 2001;12:81–88.CrossRefGoogle Scholar
8.Peterson, LR, Kelly, PJ. The role of the clinical microbiology laboratory in the management of Clostridium difficile-associated diarrhea. Infect Dis Clin North Am 1993;7:277–293.CrossRefGoogle ScholarPubMed
9.Prendergast, TM, Marini, CP, D'Angelo, AJ, Sher, ME, Cohen, JR. Surgical patients with pseudomembranous colitis: factors affecting prognosis. Surgery 1994;116:768–774.Google ScholarPubMed
10.Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:23–30.CrossRefGoogle ScholarPubMed
11.Kofsky, P, Rosen, L, Reed, J, et al. Clostridium difficile: a common and costly colitis. Dis Colon Rectum 1991;34:244–248.CrossRefGoogle ScholarPubMed
12.Riley, TV, Codde, JP, Rouse, IL. Increased length of stay due to Clostridium difficile associated diarrhea. Lancet 1995;345:455–456.CrossRefGoogle Scholar
13.MacGowan, AP, Brown, I, Feeny, R, et al. Clostridium difficile associated diarrhea and length of hospital stay. J Hosp Infect 1995;31:241–244.CrossRefGoogle ScholarPubMed
14.Jobe, BA, Grasley, A, Deveney, KE, Deveney, CW, Sheppard, BC. Clostridium difficile colitis: an increasing hospital-acquired illness. Am J Surg 1995;169:480–483.CrossRefGoogle ScholarPubMed
15.Lipsett, PA, Samantaray, DK, Bartlett, JG, Lillemoe, KD. Pseudomembranous colitis: a surgical disease? Surgery 1994;116:491–496.Google ScholarPubMed