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Population-Based Surveillance of Clostridium difficile Infection in Manitoba, Canada, by Using Interim Surveillance Definitions

Published online by Cambridge University Press:  02 January 2015

Pascal J. Lambert ,
Myrna Dyck ,
Laura H. Thompson  and
Greg W. Hammond
Pascal J. Lambert
Affiliation:
Manitoba Health and Health Living, Winnipeg, Manitoba, Canada
Myrna Dyck
Affiliation:
Manitoba Health and Health Living, Winnipeg, Manitoba, Canada Department of Community Health Sciences, Winnipeg, Manitoba, Canada
Laura H. Thompson
Affiliation:
University of Manitoba, and the National Collaborating Centre for Infectious Diseases, Winnipeg, Manitoba, Canada
Greg W. Hammond*
Affiliation:
Department of Community Health Sciences, Winnipeg, Manitoba, Canada Department of Medical Microbiology, Winnipeg, Manitoba, Canada
*
University of Manitoba, Department of Medical Microbiology, 730 William Avenue, Winnipeg, MB, CanadaR3E 0W3 (dr.greghammond@shaw.ca)
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Abstract

Objective.

TO apply interim surveillance definitions of Clostridium difficile infection (CDI) cases to 1 year of data from the provincewide surveillance system of Manitoba, Canada, to determine the epidemiology of CDI incident cases in a population.

Methods.

CDI cases were categorized with interim surveillance definitions developed by an ad hoc C. difficile surveillance working group. Incident cases recorded in the provincial CDI database between July 2005 and June 2006 were linked to the provincial hospitalization and nursing home databases and analyzed.

Results.

One thousand six incident cases were identified over 1 year. Five hundred fifteen (51%) cases were associated with and began in a healthcare facility (HCF), whereas 275 (27%) were associated with and began in the community. An additional 131 (13%) cases were HCF associated but began in the community, while 85 (8%) were of indeterminate origin. Cases of HCF-associated CDI occurred in patients who were older than did cases of community-associated CDI (P < .0001). The provincial rate of community-onset cases was 23.4 per 100,000 person-years, and rates varied among geographic areas. HCF-associated CDI rates among the 10 largest hospitals varied from 0.5 to 8.4 per 10,000 patient-days. The time to CDI onset after hospital admission indicated that 25% of nosocomial cases began by the 8th day, and 50% began by the 17th day.

Conclusions.

Although the majority of CDI cases were associated with exposure to a HCF, 40% of incident CDI began in the community. Populations with HCF- and community-associated CDI demonstrated significantly different age distributions. The wide variation of rates among HCFs requires explanation. The high percentage of incident cases in the community warrants increased study.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 945 - 951
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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