Irish Journal of Medical Science

, Volume 181, Issue 3, pp 315–320 | Cite as

Monitoring Clostridium difficile infection in an acute hospital: prevalence or incidence studies?

  • A. H. Lavan
  • D. P. McCartan
  • M. M. Downes
  • A. D. K. Hill
  • F. Fitzpatrick
Original Article
  • 132 Downloads

Abstract

Background

Surveillance of Clostridium difficile infection (CDI) is an essential component of a CDI preventative programme.

Aims

The aim of this study was to evaluate two methods of CDI surveillance.

Methods

Prevalence of CDI, antibiotic use and associated co-morbidity was assessed weekly on two wards over 6 weeks. In addition, CDI incidence surveillance was performed on all new CDI cases over a 13-week period. Cases were assessed for CDI risk factors, disease severity, response to treatment and outcome at 6 months.

Results

Clostridium difficile infection prevalence was 3.5% (range 2.9–6.1%) on the medical ward and 1.1% (range 0–3.5%) on the surgical ward. Patients on the medical ward were older and more likely to be colonised with MRSA; however, recent antibiotic use was more prevalent among surgical patients. Sixty-one new CDI cases were audited. Patients were elderly (mean age 71 years) with significant co-morbidity (median age adjusted Charlson co-morbidity score 5). CDI ribotypes included 027 (29 cases) 078 (5) and 106 (4). Eight patients developed severe CDI, seven due to 027. Antibiotic use was common with 56% receiving three or more antibiotics in the preceding 8 weeks. Twenty-four patients had died at 6 months, five due to CDI.

Conclusion

Clostridium difficile infection prevalence gives a broad overview of CDI and points to areas that require more detailed surveillance and requires little time. However, patient-based CDI incidence surveillance provides a more useful analysis of CDI risk factors, disease and outcome for planning preventative programmes and focusing antibiotic stewardship efforts.

Keywords

Clostridium difficile Surveillance Prevalence study Incidence study Ribotype 027 

Notes

Acknowledgments

This research was funded by the RCSI Alumni Student Research Programme 2008.

Conflict of interest

None.

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Copyright information

© Royal Academy of Medicine in Ireland 2012

Authors and Affiliations

  • A. H. Lavan
    • 1
  • D. P. McCartan
    • 1
  • M. M. Downes
    • 2
  • A. D. K. Hill
    • 1
  • F. Fitzpatrick
    • 2
    • 3
  1. 1.Department of SurgeryBeaumont HospitalDublin 9Ireland
  2. 2.Department of MicrobiologyBeaumont HospitalDublin 9Ireland
  3. 3.Health Protection Surveillance CentreDublinIreland

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