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Clin Infect Dis. 2015 Mar 15;60(6):831-6. doi: 10.1093/cid/ciu955. Epub 2014 Dec 4.

The importance of considering different healthcare settings when estimating the burden of Clostridium difficile.

Author information

1
Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
2
University of Iowa, Iowa City.

Abstract

BACKGROUND:

Traditional surveillance methods may underestimate the true burden of Clostridium difficile infection (CDI) because they fail to capture cases brought to medical attention in outpatient settings or diagnosed during non-face-to-face patient-provider interactions.

METHODS:

We identified CDIs diagnosed among Kaiser Permanente Northwest patients between 1 June 2005 and 30 December 2012. We categorized infections by whether they were diagnosed during an inpatient or outpatient encounter and whether they were diagnosed during a face-to-face (eg, hospitalization, outpatient visit) or non-face-to-face encounter (eg, phone, e-mail). We constructed a baseline surveillance estimate that included CDIs identified during hospitalization, representing burden captured through traditional surveillance approaches. We then constructed 2 additional estimates: 1 that included CDIs identified during outpatient face-to-face encounters and 1 that also included CDIs identified during non-face-to-face encounters.

RESULTS:

We identified 8024 CDIs. Twenty-four percent occurred during a hospitalization, while the remaining CDIs were recognized in the outpatient setting. Surveillance focused on hospitalized patients would have captured less than one-quarter of total burden. The addition of cases identified during outpatient face-to-face encounters would account for 80% of CDIs. An additional 1702 CDIs would not be captured without inclusion of non-face-to-face encounters; thus, surveillance approaches that do not include telephone or e-mail encounters would miss 21% of CDIs.

CONCLUSIONS:

Surveillance approaches that do not include outpatient or nontraditional encounters miss a substantial proportion of CDIs. Failure to capture these cases leads to underestimation of disease burden and difficulty in measuring interventions to control CDI.

KEYWORDS:

Clostridium difficile; incidence; surveillance

PMID:
25477426
DOI:
10.1093/cid/ciu955
[Indexed for MEDLINE]

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