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Volume 22, Number 4—April 2016
Research

Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings

David P. DurhamComments to Author , Margaret A. Olsen, Erik R. Dubberke, Alison P. Galvani, and Jeffrey P. Townsend
Author affiliations: Yale School of Public Health, New Haven, Connecticut, USA (D.P. Durham, A.P. Galvani, J.P. Townsend); Washington University School of Medicine, St. Louis, Missouri, USA (M.A. Olsen, E.R. Dubberke)

Main Article

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.

Main Article

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