Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) [Abridged Version] All Versions of this Article: cmaj.050978v1 cmaj.050978v2 173/9/1037    most recent Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pépin, J. Articles by Cossette, B. Search for Related Content PubMed PubMed Citation Articles by Pépin, J. Articles by Cossette, B. Related Collections Patient safety, clinical risk, medical error Clostridium difficile Related Article

Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec

From the Department of Microbiology and Infectious Diseases, University of Sherbrooke (Pépin, Valiquette), and the Department of Pharmacy, Centre hospitalier universitaire de Sherbrooke (Cossette), Sherbrooke, Que.

Correspondence to: Dr. Jacques Pépin, Centre hospitalier universitaire de Sherbrooke, 3001, 12^e Avenue Nord, Sherbrooke QC J1H 5N4; fax 819 820-6451; jacques.pepin{at}usherbrooke.ca

Background: Since 2002 an epidemic of Clostridium difficile–associated disease (CDAD) caused by a hypervirulent toxinotype III ribotype 027 strain has spread to many hospitals in Quebec. The strain has also been found in the United States, the United Kingdom and the Netherlands. The effects of this epidemic on mortality and duration of hospital stay remain unknown. We measured these effects among patients admitted to a hospital in Quebec during 2003 and 2004.

Methods: We compared mortality and total length of hospital stay among inpatients in whom nosocomial CDAD developed and among control subjects without CDAD matched for sex, age, Charlson Comorbidity Index score and length of hospital stay up to the diagnosis of CDAD in the corresponding case.

Results: Thirty days after diagnosis 23.0% (37/161) of the patients with CDAD had died, compared with 7.0% (46/656) of the matched control subjects (p < 0.001). Twelve months after diagnosis, mortality was 37.3% (60/161) among patients with CDAD and 20.6% (135/656) among the control subjects (p < 0.001), for a cumulative attributable mortality of 16.7% (95% confidence interval 8.6%–25.2%). Each case of nosocomial CDAD led, on average, to 10.7 additional days in hospital.

Interpretation: This study documented a high attributable mortality among elderly patients with CDAD mostly caused by a hypervirulent strain, which represents a dramatic change in the severity of this infection.

This article has been cited by other articles:

				I. Matte, D. Lane, E. Cote, A.-E. Asselin, L.-C. Fortier, C. Asselin, and A. Piche Antiapoptotic Proteins Bcl-2 and Bcl-XL Inhibit Clostridium difficile Toxin A-Induced Cell Death in Human Epithelial Cells Infect. Immun., December 1, 2009; 77(12): 5400 - 5410. [Abstract] [Full Text] [PDF]

				C. Deneve, S. Bouttier, B. Dupuy, F. Barbut, A. Collignon, and C. Janoir Effects of Subinhibitory Concentrations of Antibiotics on Colonization Factor Expression by Moxifloxacin-Susceptible and Moxifloxacin-Resistant Clostridium difficile Strains Antimicrob. Agents Chemother., December 1, 2009; 53(12): 5155 - 5162. [Abstract] [Full Text] [PDF]

				S. M. Twine, C. W. Reid, A. Aubry, D. R. McMullin, K. M. Fulton, J. Austin, and S. M. Logan Motility and Flagellar Glycosylation in Clostridium difficile J. Bacteriol., November 15, 2009; 191(22): 7050 - 7062. [Abstract] [Full Text] [PDF]

				L. R. Peterson and A. Robicsek Does My Patient Have Clostridium difficile Infection? Ann Intern Med, August 4, 2009; 151(3): 176 - 179. [Abstract] [Full Text] [PDF]

				U. A. Ochsner, S. J. Bell, A. L. O'Leary, T. Hoang, K. C. Stone, C. L. Young, I. A. Critchley, and N. Janjic Inhibitory effect of REP3123 on toxin and spore formation in Clostridium difficile, and in vivo efficacy in a hamster gastrointestinal infection model J. Antimicrob. Chemother., May 1, 2009; 63(5): 964 - 971. [Abstract] [Full Text] [PDF]

				S. D. Baines, R. O'Connor, K. Saxton, J. Freeman, and M. H. Wilcox Activity of vancomycin against epidemic Clostridium difficile strains in a human gut model J. Antimicrob. Chemother., March 1, 2009; 63(3): 520 - 525. [Abstract] [Full Text] [PDF]

				M. R. Mulvey PhD and A. E. Simor MD Antimicrobial resistance in hospitals: How concerned should we be? Can. Med. Assoc. J., February 17, 2009; 180(4): 408 - 415. [Full Text] [PDF]

				K. Saxton, S. D. Baines, J. Freeman, R. O'Connor, and M. H. Wilcox Effects of Exposure of Clostridium difficile PCR Ribotypes 027 and 001 to Fluoroquinolones in a Human Gut Model Antimicrob. Agents Chemother., February 1, 2009; 53(2): 412 - 420. [Abstract] [Full Text] [PDF]

				A S. Walker, D. Spiegelhalter, D. W Crook, D. Wyllie, J. Morris, and T. E A Peto Fairness of financial penalties to improve control of Clostridium difficile BMJ, November 20, 2008; 337(nov20_2): a2097 - a2097. [Full Text]

				A.-C. Labbe, L. Poirier, D. MacCannell, T. Louie, M. Savoie, C. Beliveau, M. Laverdiere, and J. Pepin Clostridium difficile Infections in a Canadian Tertiary Care Hospital before and during a Regional Epidemic Associated with the BI/NAP1/027 Strain Antimicrob. Agents Chemother., September 1, 2008; 52(9): 3180 - 3187. [Abstract] [Full Text] [PDF]

				J. R. O'Connor, M. A. Galang, S. P. Sambol, D. W. Hecht, G. Vedantam, D. N. Gerding, and S. Johnson Rifampin and Rifaximin Resistance in Clinical Isolates of Clostridium difficile Antimicrob. Agents Chemother., August 1, 2008; 52(8): 2813 - 2817. [Abstract] [Full Text] [PDF]

				P. L. Hinkson, C. Dinardo, D. DeCiero, J. D. Klinger, and R. H. Barker Jr. Tolevamer, an Anionic Polymer, Neutralizes Toxins Produced by the BI/027 Strains of Clostridium difficile Antimicrob. Agents Chemother., June 1, 2008; 52(6): 2190 - 2195. [Abstract] [Full Text] [PDF]

				B. Dupuy, R. Govind, A. Antunes, and S. Matamouros Clostridium difficile toxin synthesis is negatively regulated by TcdC J. Med. Microbiol., June 1, 2008; 57(6): 685 - 689. [Abstract] [Full Text] [PDF]

				C. Deneve, C. Delomenie, M.-C. Barc, A. Collignon, and C. Janoir Antibiotics involved in Clostridium difficile-associated disease increase colonization factor gene expression J. Med. Microbiol., June 1, 2008; 57(6): 732 - 738. [Abstract] [Full Text] [PDF]

				T. Akerlund, I. Persson, M. Unemo, T. Noren, B. Svenungsson, M. Wullt, and L. G. Burman Increased Sporulation Rate of Epidemic Clostridium difficile Type 027/NAP1 J. Clin. Microbiol., April 1, 2008; 46(4): 1530 - 1533. [Abstract] [Full Text] [PDF]

				W. N. Fawley, J. Freeman, C. Smith, C. Harmanus, R. J. van den Berg, E. J. Kuijper, and M. H. Wilcox Use of Highly Discriminatory Fingerprinting to Analyze Clusters of Clostridium difficile Infection Cases Due to Epidemic Ribotype 027 Strains J. Clin. Microbiol., March 1, 2008; 46(3): 954 - 960. [Abstract] [Full Text] [PDF]

				D. B. Blossom, F. M.T. Lewis, and L. C. McDonald The Changing Spectrum of Clostridium Difficile Associated Disease: Implications for Dentistry J Am Dent Assoc, January 1, 2008; 139(1): 42 - 47. [Abstract] [Full Text] [PDF]

				M. E. Reller, C. A. Lema, T. M. Perl, M. Cai, T. L. Ross, K. A. Speck, and K. C. Carroll Yield of Stool Culture with Isolate Toxin Testing versus a Two-Step Algorithm Including Stool Toxin Testing for Detection of Toxigenic Clostridium difficile J. Clin. Microbiol., November 1, 2007; 45(11): 3601 - 3605. [Abstract] [Full Text] [PDF]

				M. Egerer, T. Giesemann, T. Jank, K. J. F. Satchell, and K. Aktories Auto-catalytic Cleavage of Clostridium difficile Toxins A and B Depends on Cysteine Protease Activity J. Biol. Chem., August 31, 2007; 282(35): 25314 - 25321. [Abstract] [Full Text] [PDF]

				L. V McFarland Diarrhoea associated with antibiotic use BMJ, July 14, 2007; 335(7610): 54 - 55. [Full Text] [PDF]

				S. R. Curry, J. W. Marsh, C. A. Muto, M. M. O'Leary, A. W. Pasculle, and L. H. Harrison tcdC Genotypes Associated with Severe TcdC Truncation in an Epidemic Clone and Other Strains of Clostridium difficile J. Clin. Microbiol., January 1, 2007; 45(1): 215 - 221. [Abstract] [Full Text] [PDF]

				J. G. Bartlett Narrative Review: The New Epidemic of Clostridium difficile-Associated Enteric Disease. Ann Intern Med, November 21, 2006; 145(10): 758 - 764. [Abstract] [Full Text] [PDF]

				D. R. MacCannell, T. J. Louie, D. B. Gregson, M. Laverdiere, A.-C. Labbe, F. Laing, and S. Henwick Molecular Analysis of Clostridium difficile PCR Ribotype 027 Isolates from Eastern and Western Canada. J. Clin. Microbiol., June 1, 2006; 44(6): 2147 - 2152. [Abstract] [Full Text] [PDF]

				W. Liang Measuring the presence of chronic diseases. Can. Med. Assoc. J., February 14, 2006; 174(4): 500 - 500. [Full Text] [PDF]

				S. Dial, J. A. C. Delaney, A. N. Barkun, and S. Suissa Use of Gastric Acid-Suppressive Agents and the Risk of Community-Acquired Clostridium difficile-Associated Disease JAMA, December 21, 2005; 294(23): 2989 - 2995. [Abstract] [Full Text] [PDF]

				T. J. Louie How should we respond to the highly toxogenic NAP1/ribotype 027 strain of Clostridium difficile? Can. Med. Assoc. J., October 25, 2005; 173(9): 1049 - 1050. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.