Skip to main content Accessibility help

Multicenter Study of Clostridium difficile Infection Rates from 2000 to 2006

  • Erik R. Dubberke (a1), Anne M. Butler (a1), Deborah S. Yokoe (a2), Jeanmarie Mayer (a3), Bala Hota (a4), Julie E. Mangino (a5), Yosef M. Khan (a5), Kyle J. Popovich, Victoria J. Fraser (a1) and Prevention Epicenters Program from the Centers for Disease Control and Prevention...



To compare incidence rates of Clostridium difficile infection (CDI) during a 6-year period among 5 geographically diverse academic medical centers across the United States by use of recommended standardized surveillance definitions of CDI that incorporate recent information on healthcare facility (HCF) exposure.


Data on C. difficile toxin assay results and dates of hospital admission and discharge were collected from electronic databases. Chart review was performed for patients with a positive C. difficile toxin assay result who were identified within 48 hours after hospital admission to determine whether they had any HCF exposure during the 90 days prior to their hospital admission. CDI cases, defined as any inpatient with a stool toxin assay positive for C. difficile, were categorized into 5 surveillance definitions based on recent HCF exposure. Annual CDI rates were calculated and evaluated by use of the χ2 test for trend and the χ2 summary test.


During the study period, there were significant increases in the overall incidence rates of HCF-onset, HCF-associated CDI (from 7.0 to 8.5 cases per 10,000 patient-days; P < .001); community-onset, HCF-associated CDI attributed to a study hospital (from 1.1 to 1.3 cases per 10,000 patient-days; P = .003); and community-onset, HCF-associated CDI not attributed to a study hospital (from 0.8 to 1.5 cases per 1,000 admissions overall; P < .001). For each surveillance definition of CDI, there were significant differences in the total incidence rate between HCFs.


The increasing incidence rates of CDI over time and across healthcare institutions and the correlation of CDI incidence in different surveillance categories suggest that CDI may be a regional problem and not isolated to a single HCF within a community.


Corresponding author

Department of Medicine, Washington University School of Medicine, Box 8051, 660 South Euclid, St Louis, MO 63110, (


Hide All
1.Dallai, RM, Harbrecht, BG, Boujoukas, AJ, et al.Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235(3):363372.
2.Gravel, D, Miller, M, Simor, A, et al; Canadian Nosocomial Infection Surveillance Program. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009;48(5):568576.
3.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality [published correction appears in N Engl J Med 2006;354(20):2200]. N Engl J Med 2005;353(23):24422449.
4.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353(23):24332441.
5.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerglnfect Dis 2006;12(3):409415.
6.Sohn, S, Climo, M, Diekema, D, et al; Prevention Epicenter Hospitals. Varying rates of Clostridium difficile-associated diarrhea at prevention epicenter hospitals. Infect Control Hosp Epidemiol 2005;26(8):676679.
7.Campbell, RJ, Giljahn, L, Machesky, K, et al.Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30(6):526533.
8.Kutty, PK, Benoit, SR, Woods, CW, et al.Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005. Infect Control Hosp Epidemiol 2008;29(3):197202.
9.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28(2):140145.
10.Zilberberg, MD, Shorr, AF, Kollef, MH. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis 2008;14(6):929931.
11.Belmares, J, Johnson, S, Parada, JP, et al.Molecular epidemiology of Clostridium difficile over the course of 10 years in a tertiary care hospital. Clin Infect Dis 2009;49(8):11411147.
12.Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166(3):561567.
13.Dubberke, ER. The A, B, BI, and Cs of Clostridium diffidle. Clin Infect Dis 2009;49(8):11481152.
14.Samore, MH, Bettin, KM, DeGirolami, PC, Clabots, CR, Gerding, DN, Karchmer, AW. Wide diversity of Clostridium diffidle types at a tertiary referral hospital. J Infect Dis 1994;170(3):615621.
15.Dubberke, ER, Butler, AM, Hota, B, et al.Multicenter study of the impact of community-onset Clostridium difficile infection on surveillance for C. diffidle infection. Infect Control Hosp Epidemiol 2009;30(6):518525.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed