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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
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

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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