Dubberke Erik R, McMullen Kathleen M, Mayfield Jennie L, Reske Kimberly A, Georgantopoulos Peter, Warren David K, Fraser Victoria J
Washington University School of Medicine, St. Louis, Missouri, USA.
Infect Control Hosp Epidemiol. 2009 Apr;30(4):332-7. doi: 10.1086/596604.
To compare Clostridium difficile infection (CDI) rates determined with use of a traditional definition (ie, with healthcare-onset CDI defined as diagnosis of CDI more than 48 hours after hospital admission) with rates determined with use of expanded definitions, including both healthcare-onset CDI and community-onset CDI, diagnosed within 48 hours after hospital admission in patients who were hospitalized in the previous 30 or 60 days, and to determine whether differences exist between patients with CDI onset in the community and those with CDI onset in a healthcare setting.
Prospective cohort.
Tertiary acute care facility.
General medicine patients who received a diagnosis of CDI during the period January 1, 2004, through December 31, 2005.
CDI was classified as healthcare-onset CDI, healthcare facility-associated CDI after hospitalization within the previous 30 days, and/or healthcare facility-associated CDI after hospitalization within the previous 60 days. Patient demographic characteristics and medication exposures were obtained. The CDI incidence with use of each definition, CDI rate variability, patient demographic characteristics, and medication exposures were compared.
The healthcare-onset CDI rate (1.6 cases per 1,000 patient-days) was significantly lower than the 30-day healthcare facility-associated CDI rate (2.4 cases per 1,000 patient-days; P< .01) and the 60-day healthcare facility-associated CDI rate (2.6 cases per 1,000 patient-days; P< .01). There was good correlation between the healthcare-onset CDI rate and both the 30-day (correlation, 0.69; P< .01) and 60-day (correlation, 0.70; P< .01) healthcare facility-associated CDI rates. There were no months in which the CDI rate was more than 3 standard deviations from the mean. Compared with patients with healthcare-onset CDI, patients with community-onset CDI were less likely to have received a fourth-generation cephalosporin (P= .02) or intravenous vancomycin (P+ .01) during hospitalization.
Compared with the traditional definition, expanded definitions identify more patients with CDI. There is good correlation between traditional and expanded CDI definitions; therefore, it is unclear whether expanded surveillance is necessary to identify an abnormal change in CDI rates. Cases that met the expanded definitions were less likely to have occurred in patients with fourth-generation cephalosporin and vancomycin exposure.
比较使用传统定义（即医疗保健相关艰难梭菌感染定义为入院后48小时以上诊断为艰难梭菌感染）确定的艰难梭菌感染（CDI）率与使用扩展定义确定的率，扩展定义包括医疗保健相关CDI和社区获得性CDI，在过去30或60天内住院的患者入院后48小时内诊断，并确定社区获得CDI的患者与医疗保健机构获得CDI的患者之间是否存在差异。
前瞻性队列研究。
三级急症护理机构。
2004年1月1日至2005年12月31日期间被诊断为CDI的普通内科患者。
CDI分为医疗保健相关CDI、过去30天内住院后的医疗保健机构相关CDI和/或过去60天内住院后的医疗保健机构相关CDI。获取患者人口统计学特征和用药情况。比较使用每种定义的CDI发病率、CDI率变异性、患者人口统计学特征和用药情况。
医疗保健相关CDI率（每1000患者日1.6例）显著低于30天医疗保健机构相关CDI率（每1000患者日2.4例；P<0.01）和60天医疗保健机构相关CDI率（每1000患者日2.6例；P<0.01）。医疗保健相关CDI率与30天（相关性为0.69；P<0.01）和60天（相关性为0.70；P<0.01）医疗保健机构相关CDI率之间存在良好相关性。没有哪个月的CDI率超过均值3个标准差。与医疗保健相关CDI患者相比，社区获得CDI的患者在住院期间接受第四代头孢菌素（P=0.02）或静脉万古霉素（P=0.01）的可能性较小。
与传统定义相比，扩展定义可识别出更多CDI患者。传统和扩展CDI定义之间存在良好相关性；因此，尚不清楚是否需要扩大监测以识别CDI率的异常变化。符合扩展定义的病例在接受第四代头孢菌素和万古霉素治疗的患者中发生的可能性较小。
