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Recommendations for Surveillance of Clostridium difficile–Associated Disease

Published online by Cambridge University Press:  02 January 2015

L. Clifford McDonald ,
Bruno Coignard ,
Erik Dubberke ,
Xiaoyan Song ,
Teresa Horan ,
Preeta K. Kutty  and
the Ad Hoc Clostridium difficile Surveillance Working Group
L. Clifford McDonald*
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Bruno Coignard
Affiliation:
Institut de Veille Sanitaire, Saint-Maurice Cedex, France
Erik Dubberke
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Xiaoyan Song
Affiliation:
Johns Hopkins Medical Institution, Baltimore, Maryland
Teresa Horan
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Preeta K. Kutty
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Rd., MS A35, Atlanta, GA 30333 (cmcdonaldl@cdc.gov)
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Abstract

Background.

The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.

Objective and Methods.

An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.

Definitions and Recommendations.

A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 2 , February 2007 , pp. 140 - 145
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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