Impact of Clostridium difficile-associated disease in a regional hospital

Introduction / objectives

For the recent years, our institution had an incidence of Clostridium difficile associated disease (CDAD) higher than the provincial rate. This study reviewed the burden of CDAD in our hospital.

Methods

CSSSRN is a tertiary regional 230-beds acute care, with only 34 (15%) single rooms with toilet. Cases from April 2009 to March 2011 were retrieved with Nosokos, a web-base electronic surveillance software used by our Infection Control Team. Data analysis included demographics, risk factors, origin of acquisition, isolation, intra-hospital transfers and complications. The estimated daily costs per case of CDAD were 1000$/inpatient care, 200$/isolation and enhanced environmental disinfection, 300$/transfer.

Results

A total of 242 episodes of CDAD in patients were observed in 190 patients, including 57 (23,4%) recurrences. Our incidence rate was 9,6/10000 patients-days. Many cases were caused by the hyper-virulent strain NAP1/027. The median age was 75 years (range 2-98) and 57% were women. The origin of acquisition from first episodes were nosocomial 60%, transfer from another facility 9%, non nosocomial 27%, unknown 4%. Hospitalization was required in 181 episodes (75%) for a median of 7 days (range 1-167). Colectomy was performed in 5 patients, death < 30 days occurred in 12% cases . Of 13445 isolation-days, 13,5% were associated with CDAD, for an average of 1,6 CDAD isolations/100 patients-days. Also, 10357 intra-hospital transfers were done and 1,3% were CDAD cases. Using our definitions, the estimated costs of CDAD in our institution were 2 600 000 $ for the 2-year period.

Conclusion

CDAD caused severe disease, in an elderly population, with a high death rate of 12% and yearly costs of 1 300 000 $ in our institution.

Disclosure of Interest

P. Dolcé Shareholder of Nosotech, J. Blanchette: None declared, C. Ouellet: None declared, K. Levesque: None declared, H. Bernatchez: None declared.