A shift in the onset and possible transmission of Clostridium difficile infection from a hospital setting to a community setting was observed in a new study.
“C. diff infection [CDI] is a major public health concern in the US, with infection rates tripling over the last decade,” Sara Y. Tartof, PhD, Kaiser Permanente Southern California (KPSC), department of research and evaluation, said in a press release. “This study’s comprehensive view gives a more complete picture of the extent of health care-associated infections.”
Sara Y. Tartof
Researchers evaluated inpatient- and outpatient-onset burden of CDI using polymerase chain reaction (PCR) diagnostic tests in 268,655 KPSC patients (62.6% women; 44.1% white) admitted from 2011 through 2012.
CDI was identified in 1.6% of the study cohort, and infection reoccurred in 15.7% of these patients, resulting in an overall recurrence incidence rate (IR) of 6.5 cases (95% CI, 6.1-6.9) per 10,000 inpatient-days. Community-onset, health care facility-associated infections accounted for the highest IR at 11.1 (95% CI, 10.5-11.6), and IR increased from 6.9 (95% CI, 1.7-27.8) for patients aged 1 to less than 2 years to 46.8 (95% CI, 45.2-48.5) in those aged at least 65 years. Higher incidence also was observed among women (35.7; 95% CI, 34.4-37), while non-Hispanic whites had the highest IR (41.9; 95% CI, 40.3-43.44). Overall mortality within 30 days of diagnosis was 12.3%. Furthermore, mean overall CDI diagnoses increased by 34% post-PCR implementation when compared with enzyme immunoassay.
“Kaiser Permanente’s integrated health care system allowed us to track patients after they left the hospital in both the outpatient health setting and during a readmission, which contributed an important new perspective to the current C. diff story,” Tartof said in the release. “Previous studies typically focused on diagnoses during a hospital stay, which tells only part of the story. These findings emphasize how important it is to test for the infection both in the hospital as well as in outpatient settings.”
Disclosure: The researchers report no relevant financial disclosures.