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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.

Information

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