Abstract
The epidemiology of Clostridium difficile infection (CDI) has changed over time and between countries. It is therefore essential to monitor the characteristics of patients at risk of infection and the circulating strains to recognize local and global trends, and improve patient management. From December 2011 to May 2012 we conducted a prospective, observational epidemiological study of patients with laboratory-confirmed CDI at two tertiary teaching hospitals in Perth, Western Australia to determine CDI incidence and risk factors in an Australian setting. The incidence of CDI varied from 5.2 to 8.1 cases/10 000 occupied bed days (OBDs) at one hospital and from 3.9 to 16.3/10 000 OBDs at the second hospital. In total, 80 patients with laboratory-confirmed CDI met eligibility criteria and consented to be in the study. More than half (53.8%) had hospital-onset disease, 28.8% had community-onset and healthcare facility-associated disease and 7.5% were community-associated infections according to the definitions used. Severe CDI was observed in 40.0% of these cases but the 30-day mortality rate for all cases was only 2.5%. Besides a shorter length of stay among cases of community-onset CDI, no characteristics were identified that were significantly associated with community-onset or severe CDI. From 70 isolates, 34 different ribotypes were identified. The predominant ribotypes were 014 (24.3%), 020 (5.7%), 056 (5.7%) and 070 (5.7%). Whereas this study suggests that the characteristics of CDI cases in Australia are not markedly different from those in other developed countries, the increase in CDI rate observed emphasizes the importance of surveillance.
Highlights
Clostridium difficile is an important nosocomial pathogen and the most frequently diagnosed cause of infectious hospital-acquired diarrhoea
Little is known about the epidemiology of Clostridium difficile infection (CDI) in Australia
Setting and study design This was a prospective, observational, epidemiological study conducted at the Sir Charles Gairdner Hospital (SCGH), a 600-bed tertiary teaching hospital, and the Royal Perth Hospital (RPH), an 855-bed tertiary teaching hospital, both located in Perth, Western Australia
Summary
Clostridium difficile is an important nosocomial pathogen and the most frequently diagnosed cause of infectious hospital-acquired diarrhoea. Clostridium difficile infection (CDI) has a wide clinical spectrum, varying from asymptomatic carriage, to mild diarrhoea, to pseudomembranous colitis [1]. Most clinically important strains produce both toxins, toxin A-negative, toxin B-positive (AÀ B+) strains have been widely reported [4]. New Microbes and New Infections published by John Wiley & Sons Ltd on behalf of the European Society of Clinical Microbiology and Infectious Disease.
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