Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection
Multicenter Study of the Impact of Community-Onset Clostridium difficile Infection on Surveillance for C. difficile Infection
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DOI：
10.1086/597380
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发表时间：
2009-06-01
影响因子：
4.5
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
--
作者：
Dubberke, Erik R.;Butler, Anne M.;Fraser, Victoria J.
Objective.评价社区发病、医疗机构（HCF）相关艰难梭菌感染（CDI）病例对CDI发病率和暴发检测的影响。回顾性多中心队列研究。美国五所大学附属的急性护理HCF。我们收集了数据（包括C.粪便样本的艰难梭菌毒素测定）对在2000年7月1日至2006年6月30日期间在5家医院住院的所有成年患者进行。如果CDI病例在入院后超过48小时被诊断为HCF发作，或者如果在入院后48小时内被诊断为HCF相关的社区发作，并且如果患者最近从HCF出院，则将其归类为HCF。比较了四种监测定义：仅HCF发作的CDI病例（以下简称HCF发作的CDI）和在研究医院末次出院后30、60和90天内诊断的HCF发作和社区发作的HCF相关CDI病例（以下分别简称30天、60天和90天CDI）。每月CDI率进行了比较。控制图用于识别潜在的CDI爆发。在2个HCF时，30天CDI的发生率显着高于HCF发作CDI的发生率（P < .01）。在任何HCF下，30天CDI的发生率与60天或90天CDI的发生率均无统计学显著差异。每个HCF的每月HCF发病CDI率和30天CDI率之间的相关性几乎是完美的（rho范围，0.94-0.99; P <0.001）。总的来说，12个时间点的CDI率高于平均值3个标准差以上，包括11个使用HCF发作CDI定义的时间点和9个使用30天CDI定义的时间点，其中4个时间点的结果不一致（kappa = 0.794; P <0.001）。对社区发病和HCF发病、HCF相关CDI病例的跟踪可捕获显著更多的CDI病例，但仅对HCF发病、HCF相关CDI的监测就足以发现疫情。
Objective. To evaluate the impact of cases of community-onset, healthcare facility (HCF)-associated Clostridium difficile infection (CDI) on the incidence and outbreak detection of CDI.Design. A retrospective multicenter cohort study.Setting. Five university-affiliated, acute care HCFs in the United States.Methods. We collected data (including results of C. difficile toxin assays of stool samples) on all of the adult patients admitted to the 5 hospitals during the period from July 1, 2000, through June 30, 2006. CDI cases were classified as HCF-onset if they were diagnosed more than 48 hours after admission or as community-onset, HCF-associated if they were diagnosed within 48 hours after admission and if the patient had recently been discharged from the HCF. Four surveillance definitions were compared: cases of HCF-onset CDI only (hereafter referred to as HCF-onset CDI) and cases of HCF-onset and community-onset, HCF-associated CDI diagnosed within 30, 60, and 90 days after the last discharge from the study hospital (hereafter referred to as 30-day, 60-day, and 90-day CDI, respectively). Monthly CDI rates were compared. Control charts were used to identify potential CDI outbreaks.Results. The rate of 30-day CDI was significantly higher than the rate of HCF-onset CDI at 2 HCFs (P < .01). The rates of 30-day CDI were not statistically significantly different from the rates of 60-day or 90-day CDI at any HCF. The correlations between each HCF's monthly rates of HCF-onset CDI and 30-day CDI were almost perfect (rho range, 0.94-0.99; P < .001). Overall, 12 time points had a CDI rate that was more than 3 standard deviations above the mean, including 11 time points identified using the definition for HCF-onset CDI and 9 time points identified using the definition for 30-day CDI, with discordant results at 4 time points (kappa = 0.794; P < .001).Conclusions. Tracking cases of both community-onset and HCF-onset, HCF-associated CDI captures significantly more CDI cases, but surveillance of HCF-onset, HCF-associated CDI alone is sufficient to detect an outbreak.