The emergence of community-acquired Clostridium difficile in an Australian hospital
Teresa M. Wozniak A B D , George Rubin C and C. Raina MacIntyre B
+ Author Affiliations
- Author Affiliations
A NSW Public Health Officer Training Program, NSW Ministry of Health, North Sydney, NSW 2060, Australia.
B School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2033, Australia.
C Clinical Governance Unit, South Eastern Sydney Local Health District, Sydney, NSW 2000, Australia.
D Corresponding author. Email: teresa.m.wozniak@gmail.com
Healthcare Infection 20(2) 72-77 https://doi.org/10.1071/HI15003
Submitted: 24 February 2015 Accepted: 21 April 2015 Published: 19 May 2015
Abstract
Introduction: The epidemiology of Clostridium difficile-related illness is changing. This study aimed to compare risk factors between community- and hospital-acquired Clostridium difficile (C. difficile) cases.
Methods: This study was a case-series analysis in a metropolitan tertiary care hospital. A total of 136 hospitalised patients aged 18 years or older who had laboratory-confirmed C. difficile- positive stool samples between 1 September 2011 and 30 September 2012 were analysed. Data were collected electronically from hospital administrative databases. Medical records of patients with toxigenic C. difficile were retrospectively reviewed for clinical information. Data matching was used to provide event-based data of the number of cases infected with C. difficile and their hospital outcomes.
Results: A monthly average of 9% (15 of 168) of diarrhoeal stool samples were toxigenic test-positive. One-third (n = 37) of C. difficile cases had acquired infection before their hospital admission. These patients were significantly more likely to be diagnosed with enterocolitis due to C. difficile compared with patients who were infected in hospital (24% versus 7%, P = 0.02). Community-acquired C. difficile patients had significantly shorter mean lengths of stay in hospital (14 days versus 48 days for hospital-acquired infection) and were more likely to be discharged before 21 days (81% v. 38%, P < 0.001).
Conclusions: Patients with community-acquired C. difficile infection (CDI) contributed to a third of the burden of this infection in the hospital. A quarter of these patients presented to hospital with potentially life-threatening enterocolitis related to the infection. These data suggest that infection with C.difficile demands greater attention, in particular in the community setting.
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