Volume 22, Number 4—April 2016
Research
Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings
David P. Durham
, Margaret A. Olsen, Erik R. Dubberke, Alison P. Galvani, and Jeffrey P. Townsend
, Margaret A. Olsen, Erik R. Dubberke, Alison P. Galvani, and Jeffrey P. Townsend
Table 2
Calibrated posterior estimates of previously unknown epidemiologic parameters for infection with Clostridium difficile*
| Parameter description | Posterior rate (95% CI) |
|---|---|
| Hospital force of colonization† | 0.023 (0.017–0.032) |
| Base CDI transmission rate within hospital† | 1.2 × 10−2 (0.65–2.1 × 10−2) |
| Base CDI transmission rate within hospital accounting for isolation/control measures† | 6.0 × 10−3 (3.6–9.7 × 10−3) |
| Base asymptomatic transmission rate within hospital† | 4.0 × 10−4 (2.4–5.5 × 10−4) |
| Relative transmission from patients with CDI compared with asymptomatically colonized patients, accounting for isolation/control measures‡ | 15 (7.2–32) |
| LTCF force of colonization† | 3.7 × 10−3 (0.96–7.7 × 10−3) |
| LTCF transmission rate, relative to hospital‡ | 0.13 (0.068–0.22) |
| LTCF transmission rate, relative to hospital, accounting for hospital CDI isolation/control measures‡ | 0.27 (0.13–0.51) |
| Community force of colonization† | 1.2 × 10−3 (0.50–2.3 × 10−3) |
| Community transmission rate, relative to hospital‡§ | 5.2 × 10−4 (3.3–8.9 × 10−4) |
| Community transmission rate, relative to hospital, accounting for hospital CDI isolation/control measures‡ § | 1.0 × 10−3 (0.62–2.0 × 10−3) |
| Rate of community acquisition from nonhuman reservoirs§ | 1.2 × 10−3 (0.50–2.3 × 10−3) |
| Base rate of CDI developing in hospital†¶ | 2.1 × 10−4 (1.0–4.7 × 10−4) |
| Base rate of CDI developing in LTCF†¶ | 8.6 × 10−5 (1.1–22 × 10−5) |
| Base rate of CDI developing in community†¶ | 6.3 × 10−6 (2.9–12 × 10−6) |
| Base rate of CDI developing given concurrent conditions†¶ | 2.6 (0.78–6.8) |
*CDI, C. difficile infection; LTCF, long-term care facility.
†Parameter rates are per day.
‡Parameter rate expresses relative risk.
§Parameter rate represents an upper bound on the risk for transmission or acquisition within the community.
¶For a detailed decomposition of the rate of development of CDI, see the Technical Appendix.
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