Clostridium difficile?associated Disease in New Jersey Hospitals, 2000?2004

February 28, 2007 — Esther T. Tan, Corwin A. Robertson, Shereen Brynildsen, Eddy Bresnitz, Christina Tan, and L. Clifford McDonald

Abstract

Recent emergence of a virulent strain of Clostridium difficile demonstrates the importance of tracking C. difficile incidence locally. Our survey of New Jersey hospitals documented increases in the rates of C. difficile disease (by 2-fold), C. difficile-associated complications (by 7-fold), and C. difficile outbreaks (by 12-fold) during 2000-2004.

Clostridium difficile, a gram-positive organism, is the most common cause of nosocomial infectious diarrhea in the United States (1). In 2005, the Centers for Disease Control and Prevention (CDC) reported on a new, epidemic, toxin gene-variant strain of C. difficile on the basis of a study of isolates collected from hospitals in multiple states, including New Jersey. CDC recommended that inpatient healthcare facilities track the incidence of C. difficile-associated disease (CDAD), including the clinical outcomes of patients.

Conclusions

Our results demonstrate that CDAD rates and associated complications rose rapidly among New Jersey hospitals during 2000-2004. How much of the increase reflects rising awareness and how much is a true increase in incidence is unclear. Nevertheless, the trend is dramatic and consistent with published reports in the United States, Canada, and Europe that evaluated CDAD rates during earlier periods.

Our observation that a higher ICP staffing level was associated with lower CDAD rates is consistent with previous studies demonstrating that a higher ICP-to-bed ratio is associated with reduction in rates of healthcare-acquired infections. We recommend that hospitals ensure that their infection-control programs employ sufficient personnel and other resources to implement adequate infection-control practices, with the goal of decreasing CDAD rates in their institutions.

In terms of surveillance activities, almost all participating hospitals tracked C. difficile laboratory results. However, a relatively low percentage of hospitals routinely monitored CDAD complications and deaths. Given recent reports of the emergence of hypertoxin-producing C. difficile strains that are more treatment-resistant and potentially more virulent than other strains, we recommend that hospitals implement or continue comprehensive surveillance programs to track the incidence of both healthcare-acquired and community-acquired CDAD, as well as patient outcomes. Surveillance of these entities will allow ICPs to identify quickly changes in CDAD incidence and severity that could be associated with the introduction of new, more virulent strains. In addition, rapid changes in incidence and detected outbreaks should be reported to public health officials.

Despite the survey's limitations, the estimates provided from this substantial sample of acute-care hospitals are useful for hospitals to develop appropriate CDAD policies and can serve as comparison data for future infection prevention and control efforts in New Jersey and other states. Indeed, given the recent increase in the extent of C. difficile death and illness in North America and Europe, the findings in this study show that CDAD is an emerging problem, worthy of substantial investment in effective infection-control and monitoring systems.

Source:
Tan ET, Robertson CA, Brynildsen S, Bresnitz E, Tan C, McDonald LC. Clostridium difficile-associated disease in New Jersey hospitals, 2000-2004. Emerg Infect Dis [serial on the Internet]. 2007 Mar [date cited].
http://www.cdc.gov/EID/content/13/3/498.htm

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Esther T. Tan,*? Corwin A. Robertson,* Shereen Brynildsen,* Eddy Bresnitz,* Christina Tan,* and L. Clifford McDonald? (ETT, CAR, SB, EB, & CT: New Jersey Department of Health and Senior Services, Trenton, New Jersey, USA); and (ETT & CM:Centers for Disease Control and Prevention, Atlanta, Georgia, USA)