Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Quebec, Canada.
Infect Control Hosp Epidemiol. 2010 Sep;31(9):939-47. doi: 10.1086/655463.
To explore epidemiological patterns of the incidence of Clostridium difficile infection (CDI) and hospital characteristics associated with increased incidence during nonepidemic and epidemic years.
Retrospective and prospective ecological study.
Eighty-three acute care hospitals participating in CDI surveillance in the province of Quebec, Canada.
A Serfling-type regression model applied to data obtained from an administrative database (1998-2006) and prospective Quebec CDI surveillance (2004-2006) was used to calculate expected CDI baseline incidence and to detect incidence exceeding the defined epidemic threshold at the provincial and hospital level. Multivariable Poisson regression was used to determine hospital characteristics associated with increased incidence during nonepidemic (1998-2001) and epidemic (2003-2005) periods.
During the study period (1998-2006), 4,525,847 discharges, including 45,508 with a CDI in any diagnosis field, were reported by 83 hospitals. During 1998-2001, the average Quebec incidence of CDI was 10,304 cases in 1,775,822 discharges (5.8 cases per 1,000 discharges) and presented a pattern of seasonality, with similar patterns at the hospital level for some hospitals. The Quebec epidemic started in October-November 2002 and peaked in March 2004 at 845 cases in 40,852 discharges (20.7 cases per 1,000 discharges). In multivariable analysis, higher incidence was associated with location in Montreal and surrounding regions, greater hospital size, larger proportion of hospitalized elderly patients, longer length of stay, and greater proportion of comorbidities in patients, whereas teaching profile was associated with decreased incidence during both nonepidemic and epidemic periods. The effect of geographical location on incidence was greater during the epidemic.
Baseline incidence from nonepidemic years and hospital characteristics associated with CDI incidence should be taken into account when estimating the efficacy of interventions.
探索艰难梭菌感染（CDI）发病率的流行病学模式，以及与非流行和流行年份发病率增加相关的医院特征。
回顾性和前瞻性生态研究。
加拿大魁北克省 83 家急性护理医院，参与 CDI 监测。
采用 Serfling 型回归模型，应用于从行政数据库（1998-2006 年）和前瞻性魁北克 CDI 监测（2004-2006 年）获得的数据，计算预期的 CDI 基线发病率，并在省级和医院层面检测发病率是否超过定义的流行阈值。采用多变量泊松回归确定非流行（1998-2001 年）和流行（2003-2005 年）期间与发病率增加相关的医院特征。
在研究期间（1998-2006 年），83 家医院报告了 4525847 次出院，其中 45508 次在任何诊断字段中患有 CDI。1998-2001 年，魁北克的 CDI 发病率平均为 1775822 次出院中的 10304 例（每 1000 次出院 5.8 例），并呈现季节性模式，某些医院的医院层面也存在类似模式。魁北克疫情于 2002 年 10 月至 11 月开始，并于 2004 年 3 月达到顶峰，40852 次出院中有 845 例（每 1000 次出院 20.7 例）。在多变量分析中，更高的发病率与蒙特利尔及其周边地区的地理位置、更大的医院规模、住院老年患者比例较大、住院时间较长以及患者合并症比例较大有关，而教学模式与非流行和流行期间的发病率下降有关。地理位置对发病率的影响在流行期间更大。
在估计干预措施的效果时，应考虑非流行年份的基线发病率和与 CDI 发病率相关的医院特征。
