Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001
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AbstractWe reviewed Clostridium difficile–associated disease (CDAD) data from the intensive care unit (ICU) and hospital-wide surveillance components of the National Nosocomial Infections Surveillance System hospitals during 1987–2001. ICU CDAD rates increased significantly only in hospitals with 1500 beds ( ) andP!.01 correlated with the duration of ICU stay ( ;). Hospital-wide (non-ICU) rates increased only inrp 0.82 P!.05 hospitals with!250 beds ( ) and in general medicine patients versus surgery patients (). CDADP!.01 P!.0001 predominated in general hospitals versus other facility types, and rates were significantly higher during winter versus nonwinter months (). Thus, prevention efforts should be targeted to high-risk groups in theseP!.01 settings. Clostridium difficile–associated disease (CDAD) is the major hospital-acquired gastrointestinal infection in the United States . Risk factors associated with hospital-acquired CDAD include antimicrobial use, advanced age, laxative use, antineoplastic chemotherapeutic agent use, bowel colonization with C. difficile, production of toxin A, renal insufficiency, or gastrointestinal surgery or procedures [1, 2]. Over the past several years, a wide variety of reports have been published of outbreaks or perceived or real increases in the incidence of CDAD in the United States. Therefore, we conducted this study to determine secular trends in the incidence of CDAD in National Nosocomial Infections Surveillance System (NNIS) hospitals.