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Onset of Symptoms and Time to Diagnosis of Clostridium difficile–Associated Disease Following Discharge From an Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

Heidi T. Chang ,
Dorota Krezolek ,
Stuart Johnson ,
Jorge P. Parada ,
Charlesnika T. Evans  and
Dale N. Gerding
Heidi T. Chang
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Dorota Krezolek
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Stuart Johnson
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Jorge P. Parada
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
Charlesnika T. Evans
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois
Dale N. Gerding*
Affiliation:
Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
*
Research Service (151), Hines VA Hospital, Fifth Avenue and Roosevelt Road, Bldg 1, Rm C344, Hines, IL 60141 (dale.gerding2@va.gov)
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Abstract

Objective.

To identify patients with a diagnosis of Clostridium difficile–associated disease (CDAD) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials.

Design.

Single-center, retrospective study.

Methods.

Medical records were reviewed for outpatients and hospitalized patients with a stool assay positive for C. difficile toxin A from January 1998 through March 2005. Patients with recurrent CDAD or residing in an extended-care facility were excluded. CDAD in patients who had been hospitalized in the 100 days prior to diagnosis was considered potentially hospital-associated.

Results.

Of the 84 patients who met the inclusion criteria, 75 (89%) received a diagnosis 1-60 days after hospital discharge (median, 12 days), and 71 (85%) received a diagnosis within 30 days after discharge. Of the 69 patients whose records contained information regarding time of symptom onset, 62 (90%) developed diarrhea within 30 days of a previous hospital discharge, including 7 patients with symptom onset prior to discharge and 9 with onset on the day of discharge. The median time from symptom onset to diagnosis was 6 days. Of 84 patients, 77 (92%) had received antimicrobials during a prior hospitalization, but 55 (65%) received antimicrobials both as inpatients and as outpatients.

Conclusion.

If all cases of CDAD diagnosed within 100 days of hospital discharge were assumed to be hospital-associated, 71 (85%) of 84 patients with CDAD were identified within 30 days, and 75 (89%) of 84 were identified by day 60. Continued outpatient antimicrobial exposure confounds determination of whether late-onset cases are community- or hospital-associated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 926 - 931
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care cost and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 2002;34:346–353.Google Scholar
2. Levy, DG, Stergachis, A, McFarland, LV, et al. Antibiotics and Clostridium difficile diarrhea in the ambulatory care setting. Clin Ther 2000;22:91–102.Google Scholar
3. Hirschorn, LR, Trnka, Y, Onderdonk, A, Lee, M-LT, Platt, R. Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis 1994;169:127–133.CrossRefGoogle Scholar
4. McDonald, LC, Coignard, B, Dubberke, E, Song, X, et al. Recommendations for surveillance of Clostridium diffidle-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
5. Salgado, CD, Farr, BM, Calfee, DP. Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clin Infect Dis 2003;36:131–139.Google Scholar
6. Stevenson, KB, Searle, K, Stoddard, GJ, Samore, MH. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in rural communities, western United States. Emerg Infect Dis 2005;11:895–903.Google Scholar
7. Sohn, S, Climo, M, Diekema, D, et al. Varying rates of Clostridium difficile–associated diarrhea at prevention epicenter hospitals. Infect Control Hosp Epidemiol 2005;26:676–679.CrossRefGoogle ScholarPubMed
8. Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonization and disease. Lancet 1990;336:97–100.Google Scholar
9. Kyne, L, Warny, M, Qamar, A, Kelly, CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med 2000;342:390–397.Google Scholar
10. Sambol, SP, Tang, JK, Merrigan, MM, Johnson, S, Gerding, DN. Infection of hamsters with epidemiologically important strains of Clostridium difficile . J Infect Dis 2001;183:1760–1766.Google Scholar
11. al Saif, N, Brazier, JS. The distribution of Clostridium difficile in the environment of South Wales. J Med Microbiol 1996;45:133–137.CrossRefGoogle ScholarPubMed
12. O'Neill, G, Adams, JE, Bowman, RA, Riley, TV. A molecular characterization of Clostridium difficile isolates from humans, animals and their environments. Epidemiol Infect 1993;111:257–264.Google Scholar
13. Riley, TV, Cooper, M, Bell, B, Golledge, CL. Community-acquired Clostridium difficile-associated diarrhea. Clin Infect Dis 1995;20 (suppl 2): S63–S265.Google Scholar