Volume 22, Number 4—April 2016
Research
Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings
Table 1
Epidemiologic and clinical model parameters for infection with Clostridium difficile*
Parameter description | Prior rate (95% CI)† | Posterior rate (95% CI)† | Reference |
---|---|---|---|
Epidemiology | |||
All-cause CDI mortality rate, % | (28) | ||
Age, y | |||
<50 | 4.7 (2.6–7.6) | 4.5 (2.6–7.5) | |
50–64 | 12 (8.7–16) | 12 (8.5–16) | |
>65 | 16.6 (14–19) | 17 (14–19) | |
Rate at which patients complete antimicrobial drug course | 0.22 (0.17–2.29) | 0.22 (0.17–2.29) | (29) |
Rate at which recurrence develops in recovered patients | 0.13 (0.24–1) | 0.2 (0.32–1.05) | (30) |
Rate at which patients not receiving antimicrobial drugs at increased risk for CDI revert to normal risk | 0.038 (0.012–0.062) | 0.033 (0.014–0.056) | (15) |
Rate of recovery from CDI | 0.099 (0.090–0.11) | 0.099 (0.092–0.11) | (22) |
Probability that a patient recovering from primary CDI will have >1 recurrence | 22 (13–34) | 24 (15–36) | (16,17) |
Probability that a patient recovering from a first recurrence will have a second recurrence | 33 (19–48) | 34 (20–48) | (16,17) |
Probability that a patient recovering from multiple recurrences will have an additional recurrence | 56 (42–70) | 56 (41–68) | (17,18) |
Relative risk for CDI developing while a patient receives antimicrobial drugs | 8.9 (4.9–13.) | 8.3 (4.2–12) | (2,15) |
Relative risk for CDI among persons 50–65 y of age vs. those <50 y of age | 2.2 (1.4–3.4) | 2.2 (1.5–3.0) | (31) |
Relative risk for CDI among persons >65 y of age compared with those <50 y of age | 2.9 (1.9–4.4) | 3.2 (2.1–4.3) | (31) |
Spontaneous clearance of asymptomatic C. difficile colonization | 0.020 (0.015–0.025) | 0.021 (0.016–0.026) | (32) |
Hospital protocols | |||
All-cause fraction of community-onset CDI in patients who are hospitalized | 0.26 (0.23–0.28) | 0.26 (0.23–0.28) | (26) |
All-cause fraction of LTCF-onset CDI in patients who are hospitalized | 0.27 (0.23–0.32) | 0.27 (0.23–0.32) | (27) |
Increased attributable length of stay for hospitalized patients with CDI | 3.1 (2.3–4.0) | 3.1 (2.3–4.1) | (19–21) |
Effectiveness of enhanced infection control measures in reducing transmission | 53 (37–72) | 52 (37–68) | (22,23) |
Probability that a patient with CDI is properly identified and given enhanced infection control measures | 0.96 (0.93–0.99)‡ | 0.96 (0.94–0.99) | (24,25) |
Antimicrobial drug use rates | |||
Prescription rate among persons in community | (33,34) | ||
Age, y | |||
<50 | 0.0013 (0.00095–0.0017) | 0.0014 (0.00095–0.0018) | |
50–64 | 0.0014 (0.00097–0.0018) | 0.0014 (0.00097–0.0017) | |
>65 | 0.0017 (0.0013–0.0021) | 0.0017 (0.0013–0.0022) | |
Prescription rate among patients in hospital | 0.37 (0.22–0.66) | 0.37 (0.21–0.68) | (29) |
Prescription rate among patients in LTCF | 0.0054 (0.0027–0.009) | 0.0052 (0.0026–0.0087) | (35) |
*CDI, C. difficile infection; LTCF, long-term care facility.
†Parameter rates are per day unless otherwise indicated.
‡A total of 73% of sites initiated protocols before laboratory confirmation and 27% initiated protocols after confirmation. Sensitivity was 86% for laboratory tests, which yielded an effective diagnosis rate of 0.73 + 0.27 × 0.86 = 0.96.
References
- Zilberberg MD. Increase in adult Clostridium difficile–related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis. 2008;14:929–31. DOIPubMedGoogle Scholar
- Svenungsson B, Burman LG, Jalakas-Pornull K, Lagergren A, Struwe J, Akerlund T. Epidemiology and molecular characterization of Clostridium difficile strains from patients with diarrhea: low disease incidence and evidence of limited cross-infection in a Swedish teaching hospital. J Clin Microbiol. 2003;41:4031–7. DOIPubMedGoogle Scholar
- Walker AS, Eyre DW, Wyllie DH, Dingle KE, Harding RM, O’Connor L, Characterisation of Clostridium difficile hospital ward–based transmission using extensive epidemiological data and molecular typing. PLoS Med. 2012;9:e1001172. DOIPubMedGoogle Scholar
- Norén T, Akerlund T, Bäck E, Sjöberg L, Persson I, Alriksson I, Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol. 2004;42:3635–43. DOIPubMedGoogle Scholar
- Curry SR, Muto CA, Schlackman JL, Pasculle AW, Shutt KA, Marsh JW, Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis. 2013;57:1094–102. DOIPubMedGoogle Scholar
- Lanzas C, Dubberke ER, Lu Z, Reske KA, Gröhn YT. Epidemiological model for Clostridium difficile transmission in healthcare settings. Infect Control Hosp Epidemiol. 2011;32:553–61. DOIPubMedGoogle Scholar
- Otten AM, Reid-Smith RJ, Fazil A, Weese JS. Disease transmission model for community-associated Clostridium difficile infection. Epidemiol Infect. 2010;138:907–14. DOIPubMedGoogle Scholar
- Gerding DN, Johnson S. Management of Clostridium difficile infection: thinking inside and outside the box. Clin Infect Dis. 2010;51:1306–13. DOIPubMedGoogle Scholar
- Starr JM, Rogers TR, Impallomeni M. Hospital-acquired Clostridium difficile diarrhoea and herd immunity. Lancet. 1997;349:426–8. DOIPubMedGoogle Scholar
- Lofgren ET, Moehring RW, Anderson DJ, Weber DJ, Fefferman NH. A mathematical model to evaluate the routine use of fecal microbiota transplantation to prevent incident and recurrent Clostridium difficile infection. Infect Control Hosp Epidemiol. 2014;35:18–27. DOIPubMedGoogle Scholar
- Starr JM, Campbell A, Renshaw E, Poxton IR, Gibson GJ. Spatio-temporal stochastic modelling of Clostridium difficile. J Hosp Infect. 2009;71:49–56. DOIPubMedGoogle Scholar
- Yakob L, Riley TV, Paterson DL, Clements AC. Clostridium difficile exposure as an insidious source of infection in healthcare settings: an epidemiological model. BMC Infect Dis. 2013;13:376. DOIPubMedGoogle Scholar
- Rubin MA, Jones M, Leecaster M, Khader K, Ray W, Huttner A, A simulation-based assessment of strategies to control Clostridium difficile transmission and infection. PLoS ONE. 2013;8:e80671. DOIPubMedGoogle Scholar
- Dubberke ER, Butler AM, Reske KA, Agniel D, Olsen MA, D’Angelo G, Attributable outcomes of endemic Clostridium difficile–associated disease in nonsurgical patients. Emerg Infect Dis. 2008;14:1031–8. DOIPubMedGoogle Scholar
- McDonald LC, Owings M, Jernigan D. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis. 2006;12:409–15. DOIPubMedGoogle Scholar
- Galdys AL, Nelson JS, Shutt KA, Schlackman JL, Pakstis DL, Pasculle AW, Prevalence and duration of asymptomatic Clostridium difficile carriage among healthy subjects in Pittsburgh, Pennsylvania. J Clin Microbiol. 2014;52:2406–9. DOIPubMedGoogle Scholar
- Alasmari F, Seiler SM, Hink T, Burnham C-AD, Dubberke ER. Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis. 2014;59:216–22. DOIPubMedGoogle Scholar
- Loo VG, Bourgault A-M, Poirier L, Lamothe F, Michaud S, Turgeon N, Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med. 2011;365:1693–703. DOIPubMedGoogle Scholar
- Metropolis N, Rosenbluth AW, Rosenbluth MN, Teller AH, Teller E. Equation of state calculations by fast computing machines. J Chem Phys. 1953;21:1087. DOIGoogle Scholar
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