Skip to main content Accessibility help

Varying Rates of Clostridium Difficile-Associated Diarrhea at Prevention Epicenter Hospitals

  • SeJean Sohn (a1), Michael Climo (a1), Daniel Diekema (a2), Victoria Fraser (a3), Loreen Herwaldt (a2), Susan Marino (a4), Gary Noskin (a5), Trish Perl (a6), Xiaoyan Song (a6), Jerome Tokars (a7), David Warren (a3), Edward Wong (a8), Deborah S. Yokoe (a4), Theresa Zembower (a5), Kent A. Sepkowitz (a1) and Prevention Epicenter Hospitals...



Clostridium difficile-associated diarrhea (CDAD) causes substantial healthcare-associated morbidity. Unlike other common healthcare-associated pathogens, little comparative information is available about CDAD rates in hospitalized patients.


To determine CDAD rates per 10,000 patient-days and per 1,000 hospital admissions at 7 geographically diverse tertiary-care centers from 2000 to 2003, and to survey participating centers on methods of CDAD surveillance and case definition.


Each center provided specific information for the study period, including case numbers, patient-days, and hospital characteristics. Case definitions and laboratory diagnoses of healthcare-associated CDAD were determined by each institution. Within institutions, case definitions remained consistent during the study period.


Overall, mean annual case rates of CDAD were 12.1 per 10,000 patient-days (range, 3.1 to 25.1) and 7.4 per 1,000 hospital admissions (range, 3.1 to 13.1). No significant increases were observed in CDAD case rates during the 4-year interval, either at individual centers or in the Prevention Epicenter hospitals as a whole. Prevention Epicenter hospitals differed in their CDAD case definitions. Different case definitions used by the hospitals applied to a fixed data set resulted in a 30% difference in rates. No associations were identified between diagnostic test or case definition used and the relative rate of CDAD at a specific medical center.


Rates of CDAD vary widely at tertiary-care centers across the United States. No significant increases in case rates were identified. The varying clinical and laboratory approaches to diagnosis complicated comparisons between hospitals. To facilitate benchmarking and comparisons between institutions, we recommend development of a more standardized case definition.


Corresponding author

Director, Infection Control, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021.,


Hide All
1.Fekety, R, McFarland, LV, Surawicz, CM, Greenberg, RN, Elmer, GW, Mulligan, ME. Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 1997;24:324333.
2.McFarland, LV, Elmer, GW, Surawicz, CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:17691775.
3.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346353.
4.McDonald, L. Epidemiology and burden of Clostridium difficile-associated disease in US acute care hospitals: a case for new efforts in surveillance and control. Presented at the 14th Annual Meeting of the Society for Healthcare Epidemiology of America; April 17-20, 2004; Philadelphia, PA.
5.McDonald, L. Increasing incidence of Clostridium difficile-associated disease in US acute care hospitals. Presented at the 14th Annual Meeting of the Society for Healthcare Epidemiology of America; April 17-20, 2004; Philadelphia, PA.
6.Archibald, LK, Banerjee, SN, Jarvis, WR. Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001. J Infect Dis 2004;189:15851589.
7.Kleinbaum, DF, Kupper, LL, Muller, KE. Applied Regression Analysis and Other Multivariable Methods. Boston: PWS-KENT; 1988.
8.Kaplan, JE, Gase, K, Eagan, JA, Sepkowitz, KA, Sohn, S. Case definition has a substantial impact on nosocomial Clostridium difficile rates. Presented at the 14th Annual Meeting of the Society for Healthcare Epidemiology of America; April 17-20, 2004; Philadelphia, PA. Abstract 04-A-437.
9.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, LE, Silva, J Jr.Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.
10.Fekety, R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol 1997;92:739750.
11.Simor, AE, Bradley, SF, Strausbaugh, IJ, Crossley, K, Nicolle, LE, SHEA Long-Term-Care Committee. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696703.


Altmetric attention score

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