Clostridium difficile infection in Tasmanian public hospitals 2006–2010
Brett Mitchell A B C , Chris Ware A , Alistair McGregor A , Saffron Brown A and Anne Wells AA Tasmanian Infection Prevention and Control Unit, Department of Health and Human Services, Hobart, Tasmania, Australia.
B Corresponding author. Tasmanian Infection Prevention & Control Unit, Population Health, GPO Box 125, Hobart, 7001, Australia. Email: brett.mitchell@dhhs.tas.gov.au
C Australian Catholic University, PhD Student, Faculty of Health Sciences, Canberra.
Healthcare Infection 16(3) 101-106 https://doi.org/10.1071/HI11009
Submitted: 21 February 2011 Accepted: 26 May 2011 Published: 26 September 2011
Abstract
Objective: To describe the current epidemiology of Clostridium difficile infection (CDI) in Tasmania.
Design, setting and participants: Tasmania undertakes continuous surveillance for CDI at all public hospitals. Data on cases of CDI between 2006 and 2010 were examined. All positive tests occurring within 8 weeks of a previous case, and cases occurring in children less than 2 years old were excluded, consistent with national definitions. Only cases identified at public hospitals were included in the analysis.
Main outcome measures: The rate of CDI in Tasmanian hospitals over the study period and the ability to demonstrate the effect of variances in surveillance definitions.
Results: A total of 357 cases of CDI were reported over the study period – a rate of 3.08 per 10 000 patient care days (95%CI 2.90–3.27) or 0.94 per 1000 patient separations (95%CI 0.91–0.98) for hospital-identified cases of CDI. Yearly rates for the period 2006 to 2010 were 2.3, 3.2, 2.8 and 3.9 per 10 000 patient care days, respectively. The overall trend was an increase in cases over the study period. The CDI rate from 2009–10 was significantly higher than that from 2008–09. Of the total cases reported, 64% were healthcare-associated, healthcare-facility onset (HCA HFO), equating to a rate of 2.1 per 10 000 patient care days over the 4-year period.
Conclusion: The Tasmanian rate of HCA HFO is increasing, and appears to be greater than that reported by other Australian states, but is less than many northern hemisphere regions, where hypervirulent strains of C. difficile are causing increasing morbidity and mortality. It is difficult to compare reported rates of CDI nationally and internationally owing to inconsistencies in study duration, denominator selection, testing effort and testing methodology. This study demonstrates the need for national standards for CDI testing and reporting.
References
[1] Kelly C, LaMont J. Clostridium difficile – more difficult than ever. N Engl J Med 2008; 359 1932–40.| Clostridium difficile – more difficult than ever.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXhtlaitbfN&md5=c027a81f60dd9f09ede548de1a56e420CAS |
[2] Zilberberg M, Shorr A, Kollef M. Increase in adult Clostridium difficile related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis 2008; 14 929–31.
| Increase in adult Clostridium difficile related hospitalizations and case-fatality rate, United States, 2000–2005.Crossref | GoogleScholarGoogle Scholar |
[3] Lawrence S, Puzniak L, Shadel B, Gillespie K, Kollef M, Mundy L. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007; 28 123–30.
| Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure.Crossref | GoogleScholarGoogle Scholar |
[4] McGregor A, Riley T, VanGessel H. Clostridium difficile associated disease. In Cruickshank M, Ferguson J., editor. Reducing Harm to Patients from Healthcare Associated Infection: The Role of Surveillance. Sydney: Australian Commission on Safety and Quality in Healthcare; 2008.
[5] Dial SMDM, Kezouh AP, Dascal AMD, Barkun AMDM, Suissa SP. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection. CMAJ 2008; 179 767–72.
[6] Riley TV. From obscurity to ‘superbug’ – The rise of Clostridium difficile. Healthc Infect 2010; 15 59–61.
| From obscurity to ‘superbug’ – The rise of Clostridium difficile.Crossref | GoogleScholarGoogle Scholar |
[7] Mitchell B, McGregor A, Brown S. Clostridium difficile infection surveillance protocol V2.0.: Department of Health and Human Services; 2009 [cited 2010 1st June 2010]; Available from: http://www.dhhs.tas.gov.au/health_and_wellbeing/public_and_environmental_health/related_topics/tasmanian_infection_prevention_and_control_unit/publications/CDI_Surveillance_Protocol_V2.0_August_2009.pdf.
[8] Australian Commission on Safety and Quality in Healthcare. Data Dictionary and Collection Guidelines for the Surveillance of Healthcare Associated Infections: Staphylococcus aureus bacteraemia & Clostridium difficile Infection. Australian Commission on Safety and Quality in Healthcare; 2010 [cited 2010 1st December]; V3.0: [Available from: http://www.health.gov.au/internet/safety/publishing.nsf/Content/com-pubs_HAI-NatSurv-DraftDataDic.
[9] McDonald C, Coignard B, Dubberke E, Song X, Horan T, Kutty P. Recommendations for Surveillance of Clostridium difficile–Associated Disease. Infect Control Hosp Epidemiol 2007; 28 140–5.
| Recommendations for Surveillance of Clostridium difficile–Associated Disease.Crossref | GoogleScholarGoogle Scholar |
[10] Mitchell B, McGregor A. Microbiology laboratory testing for Clostridium difficile in Tasmania. In Ware C, editor. Hobart: Department of Health and Human Services; 2010.
[11] Price MF, Dao-Tran T, Garey KW, Graham G, Gentry LO, Dhungana L, et al Epidemiology and incidence of Clostridium difficile-associated diarrhoea diagnosed upon admission to a university hospital. J Hosp Infect 2007; 65 42–6.
| Epidemiology and incidence of Clostridium difficile-associated diarrhoea diagnosed upon admission to a university hospital.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28jltVansw%3D%3D&md5=fdabbab138b08d2735c10733e7bbc8deCAS |
[12] Van Gessel H. Measuring the incidence of Clostridium difficile-associated diarrhoea in a group of Western Australian hospitals. Healthc Infect 2008; 13 56–62.
| Measuring the incidence of Clostridium difficile-associated diarrhoea in a group of Western Australian hospitals.Crossref | GoogleScholarGoogle Scholar |
[13] Elliott B, Chang BJ, Golledge CL, Riley TV. Clostridium difficile-associated diarrhoea. Intern Med J 2007; 37 561–8.
| Clostridium difficile-associated diarrhoea.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2svit1Kjug%3D%3D&md5=d95e778232bd8fa895d2fc64867bc5ecCAS |
[14] Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005; 353 2442–9.
| A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXhtlShurvK&md5=720bf4aa8fcdcf990c4251c8d2ea6c00CAS |
[15] Thomas C, Stevenson M, Williamson D, Riley T. Clostridium difficile associated diarrhoea: epidemiological data from Western Australia associated with a modified antibiotics policy. Clin Infect Dis 2002; 35 1457–62.
| Clostridium difficile associated diarrhoea: epidemiological data from Western Australia associated with a modified antibiotics policy.Crossref | GoogleScholarGoogle Scholar |
[16] Sohn S, Climo M, Diekema D, Fraser V, Herwaldt L, Marino S, et al Varying Rates of Clostridium difficile Associated Diarrhea at Prevention Epicenter Hospitals. Infect Control Hosp Epidemiol 2005; 26 676–9.
| Varying Rates of Clostridium difficile Associated Diarrhea at Prevention Epicenter Hospitals.Crossref | GoogleScholarGoogle Scholar |
[17] Health Protection Agency. Results of the mandatory Clostridium difficile reporting scheme – Acute Trust Counts and Rates by Quarter and Financial year- April 2007 onwards. London: Health Protection Agency; 2010 [cited 2010 3rd September 2010]; Available from: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1278944234025.
[18] Van Gessel H, Riley T, McGregor A. Clostridium difficile infection: an update for infection control practitioners. Healthc Infect 2009; 14 115–8.
| Clostridium difficile infection: an update for infection control practitioners.Crossref | GoogleScholarGoogle Scholar |
[19] Jarvis WR, Schlosser JA, Jarvis AA, Chinn RY. National point prevalence of Clostridium difficile in US health care facility inpatients, 2008. Am J Infect Control 2009; 37 263–70.
[20] Lambert PJ, Dyck M, Thompson LH, Hammond GW. Population based surveillance of Clostridium difficile infection in Manitoba, Canada, by using interim surveillance definitions. Infect Control Hosp Epidemiol 2009; 30 945–51.
[21] Paltansing S, Van Den Berg RJ, Guseinova RA, Visser CE, Van Der Vorm ER, Kuijper EJ. Characteristics and incidence of Clostridium difficile-associated disease in The Netherlands, 2005. Clin Microbiol Infect 2007; 13 1058–64.
| 1:STN:280:DC%2BD2sngtVKisA%3D%3D&md5=c8ebf09041e23f9b4be22eb4bbba1b00CAS |
[22] Asensio A, Vaque-Rafart J, Calbo-Torrecillas F, Gestal-Otero J, López-Fernández F, Trilla-Garcia A, Canton R. Increasing rates in Clostridium Difficile infection (CDI) among hospitalised patients, Spain 1999–2007. Eurosurveillance 2008; 13 18 943
[23] Barbut F, Gariazzo B, Bonne L, Lalande V, Burghoffer B, Luiuz R, et al Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: results of a retrospective study, 2000–2004. Infect Control Hosp Epidemiol 2007; 28 131–9.
[24] Health Protection Agency (2011). Voluntary surveillance of Clostridium difficile in England, Wales and Northern Ireland, 2010. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1296681242219.