Hospital-based epidemiology: a strategy for 'dealing with Clostridium difficile'

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Clostridium difficile-associated diarrhoea (CDAD) presents ongoing infection control challenges.
• Diagnostic methods and case provenance definitions for CDAD require clarification.
• Understanding local CDAD epidemiology is vital for targeted interventions.

Purpose of the Study:

• To investigate the local epidemiology of CDAD in a UK teaching hospital.
• To analyze incidence, patient demographics, acquisition sources, and mortality associated with CDAD.
• To evaluate the impact of varying definitions on community-acquired CDAD classification.

Main Methods:

• Prospective epidemiological study of 275 new CDAD cases (general practitioner and hospital).
• Analysis of case incidence by hospital department and age distribution.
• Assessment of community-acquired definitions and 90-day all-cause mortality data.

Main Results:

• Highest incidence observed in haematology and critical care units.
• 29% of hospital cases occurred in patients under 65 years old.
• Significant variability in defining community-acquired CDAD complicates inter-trust comparisons; 25% of hospitalized patients died within 30 days.

Conclusions:

• Local epidemiological data are essential for infection prevention and control planning within NHS trusts.
• Findings contribute to the evidence base for national CDAD targets and policies.
• The study highlights the need for standardized definitions to ensure accurate reporting and comparisons.