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Assessment of Clostridium difficile–Associated Disease Surveillance Definitions, North Carolina, 2005

Published online by Cambridge University Press:  02 January 2015

Preeta K. Kutty ,
Stephen R. Benoit ,
Christopher W. Woods ,
Arlene C. Sena ,
Susanna Naggie ,
Joyce Frederick ,
John Engemann ,
Sharon Evans ,
Brian C. Pien  and
Shailendra N. Banerjee
...Show all authors
Preeta K. Kutty
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia Epidemic Intelligence Service, Division of Applied Public Health Training, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Stephen R. Benoit
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Christopher W. Woods
Affiliation:
Department of Veterans Affairs Medical Center, Durham Duke University Medical Center, Division of Infectious Diseases, Durham
Arlene C. Sena
Affiliation:
Durham County Health Department, Durham Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Susanna Naggie
Affiliation:
Department of Veterans Affairs Medical Center, Durham Duke University Medical Center, Division of Infectious Diseases, Durham
Joyce Frederick
Affiliation:
Department of Veterans Affairs Medical Center, Durham
John Engemann
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Sharon Evans
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Brian C. Pien
Affiliation:
Duke University Medical Center, Division of Infectious Diseases, Durham
Shailendra N. Banerjee
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
Jeffery Engel
Affiliation:
North Carolina Department of Health and Human Services, Raleigh, North Carolina
L. Clifford McDonald*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, MS A-31, 1600 Clifton Rd NE, Atlanta, GA 30333 (CMcDonaldl@cdc.gov.)
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Abstract

Objective.

To determine the timing of community-onset Clostridium difficile–associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility–onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.

Design.

Retrospective cohort study for the period January 1, 2005, through December 31, 2005.

Setting.

Catchment areas of 6 acute care hospitals in North Carolina.

Methods.

We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin–assay results. Cases were classified as healthcare facility–onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility–associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility–onset, healthcare facility–associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases.

Results.

Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P<.001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included.

Conclusions.

A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility–associated CDAD that includes cases that occur within 4 weeks after discharge.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 3 , March 2008 , pp. 197 - 202
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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