Artificial Differences in Clostridium difficile Infection Rates Associated with Disparity in Testing

Area of Science:

• Infectious Diseases
• Epidemiology
• Healthcare Quality

Background:

• Clostridium difficile infection (CDI) is a significant healthcare-associated pathogen.
• Accurate surveillance of CDI is crucial for effective infection control and patient safety.
• Variations in diagnostic testing practices can impact reported CDI rates.

Purpose of the Study:

• To analyze Clostridium difficile testing rates and hospital-onset infection rates across different hospital types in the US.
• To investigate the potential relationship between testing frequency and reported CDI rates.
• To inform C. difficile surveillance strategies.

Main Methods:

• Retrospective analysis of 2015 data from 30 US community, multispecialty, and cancer hospitals.
• Calculation of Clostridium difficile testing rates per 1,000 patient-days.
• Calculation of pooled hospital-onset C. difficile infection rates per 1,000 patient-days.

Main Results:

• In 2015, Clostridium difficile testing rates were 14.0/1,000 patient-days in community hospitals, 16.3 in multispecialty hospitals, and 33.9 in cancer hospitals.
• Pooled hospital-onset C. difficile infection rates were 0.56/1,000 patient-days in community hospitals, 0.84 in multispecialty hospitals, and 1.57 in cancer hospitals.
• Higher testing rates correlated with higher reported infection rates across hospital types.

Conclusions:

• Increased Clostridium difficile testing frequency may artificially elevate reported CDI rates.
• Current surveillance methods may not adequately account for variations in diagnostic intensity.
• Recommendations for C. difficile surveillance should incorporate an analysis of testing frequency to ensure accurate incidence reporting.